Ogawa K
Department of Respiratory Disease, Higashi Nagoya National Hospital, Japan.
Kekkaku. 1997 Feb;72(2):119-24.
Systemic or topical treatment with antifungal agents are applied for the treatment of chronic pulmonary aspergillosis (fungus ball type, mural thickness type). Recently, the concomitant treatment with elastase inhibitor has been studied for the purpose of relieving tissue destruction by inhibiting elastase derived from aspergillus species. In the present study, we have examined the clinical effect of the topical treatment with Amphotericin B in patients with chronic pulmonary aspergillosis, and the concomitant use of Ulinastatin has also been examined in patients with symptoms such as hemosputum and hemoptysis. Amphotericin B was administered by transcatheter intracavity injection or transbronchial intrapulmonary injection. In some patients, inhalation was concomitantly employed. Amphotericin B was challenged by inhalation before starting the topical treatment, and if the patient experienced an asthma like attack, the present therapies were not conducted. Ulinastatin was administered by intravenous drip infusion concomitantly with antifungal agents and hemostatics. As a result, improvements regarding antifungal effects and clinical symptoms were found in 12 out of 15 patients treated with Amphotericin B. Further, early disappearance of hemosputum and hemoptysis was seen in 11 out of 23 episodes in 14 patients concomitantly treated with Ulinastatin. The treatment-related side effects, leading to discontinuation of those therapies, did not occur. Immunoresponse of allergy was studied in the patients ineligible for Amphotericin B topical treatment and the non-responders to Ulinastatin, and aspergillus specific IgE antibodies in serum were increased in the majority of patients. From the above results, it is desirable to carry out the topical treatment in chronic pulmonary aspergillosis. Also, it was considered valuable to apply the concomitant treatment with Ulinastatin, elastase inhibitor, to patients with severe clinical symptoms of hemosputum and hemoptysis.
抗真菌药物的全身或局部治疗用于慢性肺曲霉病（真菌球型、壁增厚型）的治疗。最近，为了通过抑制曲霉属产生的弹性蛋白酶来减轻组织破坏，人们对弹性蛋白酶抑制剂的联合治疗进行了研究。在本研究中，我们检查了两性霉素B局部治疗对慢性肺曲霉病患者的临床效果，并且还在有咯血和咯血等症状的患者中检查了乌司他丁的联合使用情况。两性霉素B通过经导管腔内注射或经支气管肺内注射给药。在一些患者中，同时采用吸入治疗。在开始局部治疗前通过吸入给予两性霉素B，如果患者出现类似哮喘的发作，则不进行当前治疗。乌司他丁与抗真菌药物和止血剂同时通过静脉滴注给药。结果，在接受两性霉素B治疗的15名患者中，有12名患者的抗真菌效果和临床症状得到改善。此外，在14名同时接受乌司他丁治疗的患者中，23次发作中有11次咯血和咯血早期消失。未出现导致这些治疗中断的治疗相关副作用。对不符合两性霉素B局部治疗条件的患者和对乌司他丁无反应的患者进行了过敏免疫反应研究，大多数患者血清中的曲霉特异性IgE抗体增加。根据上述结果，在慢性肺曲霉病中进行局部治疗是可取的。此外，将乌司他丁（一种弹性蛋白酶抑制剂）联合治疗应用于有严重咯血和咯血临床症状的患者被认为是有价值的。
