Greenberger P A
Department of Medicine, Northwestern University Medical School, Chicago, Illinois.
Allergy Proc. 1994 Nov-Dec;15(6):335-9. doi: 10.2500/108854194778816463.
Early diagnosis and treatment is essential for patients afflicted with bronchopulmonary aspergillosis (ABPA). Inflammatory damage to the airways may be significantly reduced through use of corticosteroids. Without treatment, bronchiectasis causing permanent anatomic alteration of the airways may occur. ABPA should be considered in any asthmatic who requires oral corticosteroids and has recurrent pulmonary infiltrates. Evaluation should include determination of total serum IgE, which generally exceeds 1000 ng/mL in patients with ABPA. Disease categorization of ABPA patients may be made according to radiographic and clinical considerations into five stages. The treatment choice for ABPA is prednisone, although inhaled corticosteroids including beclomethasone dipropionate may also be used in long-term asthma management. Successful therapy of ABPA is typically associated with a decline in total serum IgE, subsequent exacerbations often being associated with elevation in total serum IgE. Allergen avoidance is essential for the ABPA patient, as exposure to heavy concentrations of fungi may precipitate disease exacerbation.
对于罹患支气管肺曲霉菌病（ABPA）的患者而言，早期诊断和治疗至关重要。使用皮质类固醇可显著减轻气道的炎症损伤。若不进行治疗，可能会发生导致气道永久性解剖结构改变的支气管扩张。对于任何需要口服皮质类固醇且有反复肺部浸润的哮喘患者，均应考虑ABPA。评估应包括测定血清总IgE，ABPA患者的血清总IgE通常超过1000 ng/mL。可根据影像学和临床因素将ABPA患者的病情分为五个阶段。ABPA的治疗选择是泼尼松，不过包括二丙酸倍氯米松在内的吸入性皮质类固醇也可用于长期哮喘管理。ABPA的成功治疗通常与血清总IgE下降相关，随后的病情加重往往与血清总IgE升高有关。对于ABPA患者，避免接触过敏原至关重要，因为接触高浓度真菌可能会促使病情加重。
