支气管扩张患者中变应性支气管肺曲霉病的患病情况及临床特征分析

• 作者： 陈爱 ¹ 孙丽娜 ¹ 任佳琪 ¹ 常春 ¹ 陈亚红 ¹ 孙永昌 ¹
• 作者单位：
  1.  100191 北京市，北京大学第三医院呼吸与危重症医学科 北京大学医学部慢性气道疾病研究中心
• 提交时间：2023-06-02

摘要: 背景 变应性支气管肺曲霉病（ABPA）是曲霉致敏引起的一种肺部疾病，由于患病率较低、病例报道较少、诊断标准存在争议，早期常被误诊、漏诊，导致治疗不当、病情加重。既往研究表明ABPA是支气管扩张（以下简称支扩）的病因之一，但其具体患病情况及临床特征还有待研究。目的 分析支扩患者中ABPA的患病情况及临床特征。方法 选取2012年1月2021年9月于北京大学第三医院诊断为支扩，同时检测了外周血嗜酸粒细胞、血清总IgE、曲霉特异性IgE的门诊或住院患者，收集患者的性别、年龄、吸烟史、哮喘/喘息症状、实验室指标（外周血嗜酸粒细胞计数，血清总IgE、烟曲霉特异性IgE和血清烟曲霉特异性IgG）、胸部CT（支扩类型、受累肺叶数）及肺功能指标〔第1秒用力呼气容积占预计值百分比（FEV1%pred）、第1秒用力呼气容积/用力肺活量比值（FEV1/FVC）〕。采用Smith评分评估支气管扩张的病变范围、Bhalla评分评估支气管扩张病变的严重程度。根据是否为ABPA将患者分为ABPA组10例和非ABPA组149例，并分析患者血清总IgE>60U/mL、血清总IgE>500U/mL、血清总IgE>1000U/mL、曲霉特异性IgE>0.35U/mL、外周血嗜酸性粒细胞>0.510^9/L的情况。结果 159例支扩患者中ABPA10例，7例有发作性喘息症状；作为诊断ABPA的必要条件，10例患者血清曲霉特异性IgE水平均升高（>0.35U/mL）；9例血清总IgE>1000U/mL，1例血清总IgE水平0.510^9/L、影像学支扩、血清曲霉特异性IgG阳性）；9例患者外周血嗜酸性粒细胞绝对值>0.510^9/L。10例患者中5例检测了曲霉特异性IgG，其中4例阳性。10例ABPA患者中有6例胸部CT符合中央型支扩，4例为非中央型支扩；均表现为囊状支扩。ABPA组受累肺叶数目、Smith评分和Bhalla评分均高于非ABPA组（P<0.05）。结论 在本中心诊断为支扩的患者中，部分病例符合ABPA诊断标准，提示对于中央型支扩或支扩程度较重、外周血嗜酸粒细胞增多的患者，应进行总IgE和曲霉特异性IgE检测，以利于ABPA的早期诊断。

Abstract: Background Allergic bronchopulmonary aspergillosis（ABPA） is a lung disease caused by aspergillus sensitization，which is often misdiagnosed or missed diagnosis due to low prevalence，few case reports，and controversial diagnostic criteria，leading to inappropriate treatment and exacerbation of the disease. Previous studies have shown that ABPA is one of the etiologies of bronchiectasis，but its prevalence and clinical characteristics still remain to be studied. Objective To analyze the prevalence and clinical characteristics of ABPA in patients with bronchiectasis. Methods Outpatients or inpatients diagnosed with bronchiectasis and received examinations for peripheral blood eosinophilcount，serum total IgE and aspergillus- specific IgE at Peking University Third Hospital from January 2012 to September 2021 were retrospectively selected. The data including gender，age，smoking history，asthma/wheezing symptoma，laboratory indicators（peripheral blood eosinophil count，serum total IgE，aspergillus-specific IgE and IgG），chest CT（types of bronchiectasis，number oflobes involved），and pulmonary function indexes〔the first forced expiratory volume as a percentage of the predicted value（FEV1%pred），ratio of the first forced expiratory volume and forced vital capacity in percentage（FEV1/FVC）〕was collected. The Smith score and the Bhalla score was used to evaluate the extent and the severity of bronchiectasis lesions，respectively. The included patients were divided into the ABPA group（n=10） and non-ABPA group（n=149）according to the combination of ABPA and analyzed for the cases with total serum IgE>60 U/mL，total serum IgE> 500 U/mL，total serum IgE>1 000 U/mL，aspergillus-specific IgE>0.35 U/mL，and peripheral blood eosinophils > 0.510^9/L. Results In 159 patients with bronchiectasis，10 cases met the diagnostic criteria of ABPA （6.29%，10/159）with elevated aspergillus-specific IgE level（>0.35 U/mL），including 9 cases with aspergillus-specific IgE level >1 000 U/mL and 1 case with aspergillus-specific IgE level0.510^9/L，radiological bronchiectasis，positive serum aspergillus-specific IgG），of whom 7 cases had episodic wheezingsymptom and 9 cases with absolute peripheral blood eosinophilia>0.510^9/L.Aspergillus-specific IgG was detected in 5 of the 10 cases with ABPA，4 of whom were positive. Chest CT findings showed central bronchiectasis and peripheral bronchiectasis in 6 and 4 of the 10 cases with ABPA，and cystic bronchiectasis were shown in all 10 cases. Compared with the non-ABPA group，the ABPA group showed a higher number of lung lobesinvolved，Smith score and Bhalla score （P<0.05）. Conclusion Some casesmet the diagnostic criteria of ABPA among the patients diagnosed with bronchiectasis in the center，suggesting that total IgE and aspergillus-specific IgE should be detected in patients with central or severe bronchiectasis and increased peripheral blood eosinophils for the early diagnosis of ABPA.

• 分类： 医学、药学 >> 预防医学与公共卫生学
• 引用： ChinaXiv:202306.00021 (或此版本 ChinaXiv:202306.00021V1)
  DOI:10.12114/j.issn.1007-9572.2023.0135
  CSTR:32003.36.ChinaXiv.202306.00021.V1
• 推荐引用方式： 陈爱,孙丽娜,任佳琪,常春,陈亚红,孙永昌.(2023).支气管扩张患者中变应性支气管肺曲霉病的患病情况及临床特征分析.中国全科医学.doi:10.12114/j.issn.1007-9572.2023.0135 (点此复制)