摘要目的 提高对变应性支气管肺霉菌病(allergic bronchopulmonary mycosis,ABPM)的认识和诊断水平.方法 回顾性分析2010年1月至2012年9月在复旦大学附属中山医院就诊的血清霉菌特异性IgE阳性的95例支气管哮喘(简称哮喘)患者的临床资料,分为ABPM组(59例)和霉菌过敏性哮喘(mycosis hypersensitivity,MH)组(36例),从临床症状、实验室检查、肺功能和胸部CT等方面进行综合分析.结果 95例患者中,ABPM组59例(62％),其中女25例,男34例,年龄(53±4)岁,哮喘病史(21±4)年；MH组36例(38％),其中女26例,男10例,年龄(46±6)岁,哮喘病史(16±5)年.ABPM组临床症状比MH组更明显,表现为气喘(分别为52例和21例,x2=11.159,P=0.001)、咳嗽(分别为54例和27例,x2=4.859,P=0.030)、咳痰(分别为43例和9例,x2=25.731,P =0.000).ABPM组烟曲霉特异性IgE阳性58例,青霉菌特异性IgE阳性34例,单纯青霉菌特异性IgE阳性1例；MH组烟曲霉特异性IgE阳性15例,青霉菌特异性IgE阳性24例,单纯青霉菌特异性IgE阳性17例.ABPM组烟曲霉特异性IgE阳性比例高于MH组(分别为58例和15例,x2=24.500,P=0.000),而屋尘螨和粉尘螨特异性IgE阳性比例较低(分别为21例和20例,x2=3.632,P=0.045；分别为17例和21例,x2=8.118,P=0.004)；ABPM组与MH组相比,ABPM组血清总IgE升高[分别为(4395±1437) IU/ml和(276±133) IU/ml,t=4.384,P=0.000],外周血嗜酸粒细胞百分比[分别为(12.56± 1.20)％和(1.30±0.15)％,t=8.175,P=0.000]和计数[分别为(2.09±0.43)×109/L和(0.19±0.04)×109/L,t=7.032,P=0.000]均升高,肺功能指标(FEV1占预计值％)稍降低[分别为(70.2±2.3)％和(78.3±3.2％)％,t=2.011,P=0.038].胸部CT检查ABPM组41例(69.5％)可见中心性支气管扩张,18例(30.5％)可见黏液栓,MH组胸部CT未见异常.结论 哮喘患者中,ABPM并非少见,临床常存在漏诊和误诊,应提高临床医生的认识,做到早期诊断和治疗.

abstractsObjective To improve understanding of the clinical characteristics and diagnosis of allergic bronchopulmonary mycosis (ABPM).Methods We retrospectively analyzed the clinical data,including clinical symptoms,laboratory tests,pulmonary function tests and chest CT imaging of 95 asthmatic patients with positive serum mycosis-specific IgE from January 2010 to September 2012 in Zhongshan Hospital Affiliated to Fudan University.Results Of the 95 patients,59 cases met the diagnostic criteria of ABPM.There were 34 males and 25 females,with a mean age of (53 ± 4) years and a duration of asthma for (21 ±4) years.Thirty-six cases showed mycosis hypersensitivity (MH).There were 10 males and 26females,with a mean age of (46 ± 6) years and a duration of asthma for (16 ± 5) years.Clinical symptoms such as wheeze (52 vs 21,x2 =11.159,P =0.001),cough (54 vs 27,x2 =4.859,P =0.030) and expectoration (43 vs 9,x2 =25.731,P =0.000) were more common in the ABPM group compared to the MH group.In the ABPM group,58 were A.fumigatus-specific IgE antibody positive,34 Penicillium-specific IgE antibody positive and 1 only Penicillium-specific IgE antibody positive.While in the MH group,15 were A.fumigatus-specific IgE antibody positive,24 Penicillium-specific IgE antibody positive and 17 only Penicillium-specific IgE antibody positive.In the ABPM group,the percentage of positive fumigatus-specific IgE antibody was higher (58 vs 15,x2 =24.500,P =0.000),while the percentages of dermatophagoides pteronyssinus (21 vs 20,x2 =3.632,P =0.045) and Dermatophagoides farinae (17 vs 21,x2 =8.118,P =0.004) were lower.Total serum IgE [(4395 ± 1437) IU/ml vs (276 ± 133) IU/ml,T =4.384,P =0.000],peripheral eosinophil percentage [(12.56 ± 1.20) ％ vs (1.30 ± 0.15) ％,t =8.175,P =0.000]and count [(2.09 ±0.43) × 109/L vs (0.19 ±0.04) × 109/L,t =7.032,P =0.000] were higher in the ABPM group as compared to the MH group.FEV1 ％ slightly declined in the ABPM group [(70.2 ± 2.3)％vs (78.3 ±3.2％)％,t =2.011,P =0.038].Forty-one cases (69.50％) had central bronchiectasis and 18 (30.50％) had mucus plugs in the ABPM group.Chest CT scan was normal in the MH group.Conclusions ABPM is common in asthmatic patients but has long been underestimated and misdiagnosed.Efforts need to be intensified to improve the awareness among clinicians for early diagnosis and treatment of the disease.