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1、变态反应性支气管肺曲霉病1例并文献复习作者：尚玉龙，罗为，陆娟，李赞，马绍磊【摘要】目的总结分析变态反应性支气管肺曲霉病(ABPA)的临床特点，以提高对ABPA的认识，做到早诊断、早治疗。方法对1例确诊的ABPA患者的病史、临床表现、胸部CT、实验室检查结果及疗效并结合有关文献进行回顾性分析。结果本例患者有哮喘病史，在诊断ABPA之前至少被误诊12年。回顾性分析至2008年5月份以前国内可检索到的ABPA病例共91例，均有误诊，误诊时间为3个月～40年，被误诊为的疾病有肺结核、肺炎、肺癌、Wege
2、ner肉芽肿等，误诊为肺结核最为常见。临床症状无特异性，特征性的中央型支气管扩张对诊断ABPA有重要意义。结论我国ABPA报道病例较少，尚无国内的诊治指南。临床上ABPA极易误诊，应该提高对ABPA的诊断意识，若患者有气喘表现，肺部出现游走性浸润影、中央型支气管扩张，可进一步查总IgE、烟曲菌特异性IgE、烟曲菌过敏原皮试等以便早确诊及治疗。【关键词】变态反应性支气管肺曲霉病；诊断 Abstract：ObjectiveTosummarizeandanalyzetheclinicalfeature
3、sofallergicbronchopulmonaryaspergillosis(ABPA)soastoraiseawarenessofABPAandtoenableitsearlydiagnosis11andearlytreatment.MethodsTheclinicaldataofanABPApatientwhowasdiagnosedinourdepartmentwereanalyzedretrospectively,includingcasehistory,clinicalmanifes
4、tations,chestCTphotos,laboratoryresultsandtherapeuticefficacy,incombinationwiththeliteraturereviewed.ResultsThepatienthadahistoryofasthma,andhadbeenmisdiagnosedforatleast12yearsbeforethediagnosisofABPA.Retrospectiveanalysisoftheliteraturereviewedrevea
5、ledthatatotalof91casesofABPAcouldberetrievedfromdomesticdatabasesuntilMay2008,allofwhichhadmisdiagnosesrangingfrom3monthsto40years.Themisdiagnosesincludedpulmonarytuberculosis,pneumonia,lungcancer,Wegener′sgranulomatosis,etc.,withpulmonarytuberculosis
6、onthetop.ABPAhasnospecificclinicalsymptoms,whileitscharacteristiccentralbronchiectasisisofgreatsignificanceinABPAdiagnosis.ConclusionsThereareveryfewcasereportsofABPA,andthereisnonationalguidelinesforitsdiagnosisandtreatment.ABPAiseasytomisdiagnosecli
7、nically,whichrequiresthattheawarenessofABPAdiagnosisberaised.Ifthepatientshasasthma,accompaniedbypulmonarymigratoryinfiltratesandcentralbronchiectasis,furtherexaminationsofthetotalIgE,Aspergillusfumigatus-specificIgEandskintest11forAspergillusfumigatu
8、sallergenarerequiredtofacilitatetheearlydiagnosisandtreatment. Keywords:allergicbronchopulmonaryaspergillosis;diagnosis 变态反应性支气管肺曲霉病(allergicbronchopulmonaryaspergillosis，ABPA)是人体对曲霉菌发生超敏反应引起的一种疾病。ABPA在我国不常见，发病率不详。由于临床医师对该病了解不足，常需很长时间才能确诊，且常
