| BackgroundABPA is a kind of immune-mediated lung disorder. It is mainly caused by hypersensitivity to A. fumigatus and mainly occurred in bronchial asthma and pulmonary cystic fibrosis patients. Clinical manifestations of ABPA lack specificity, so ABPA can be easily misdiagnosed. If patients cannot get reasonable and timely treatment, it can develop to bronchial dilation or pulmonary interstitial fibrosis, even cause death.ObjectiveTo analyze clinical characteristics of ABPA,immunological parameters and imaging features of ABPA and evaluate the diagnostic value of them respectively. To make the diagnostic criteria simple. What’s more, we hope that our study can help improve the recognition and diagnosis of ABPA, so as to treat them in time and prevent irreversible lung damage from happening.MethodsTo collect the clinical data of 17 patients diagnosed with ABPA from January 2013 to February 2016 in Qilu Hospital of Shandong University and to perform a retrospectively analysis of these data. All patients took glucocorticoid as foundation treatment. We compared the laboratory indexes (A. fumigatus specific IgE, serum total IgE, Aspergillus skin test peripheral and blood eosinophil ratio,) and imaging performance before and after treatment to assess the therapeutic efficacy to determine the optimal follow-up indicators.Results17 cases were diagnosed with ABPA,8 cases were male and 9 cases were female, age range of 36 to 68. Before diagnosed with ABPA, they had been misdiagnosed with bronchial asthma (asthma), bronchial dilation, tuberculosis, pneumonia, lung cancer or eosinophilic pneumonia. The main clinical manifestations were as followed: cough in 17 cases (100.00%). spytum production in 16 cases (94.11%), wheezing in 14 cases (82.35%), chest distress in 11 cases (64.71%), fever in 10 cases (58.82%), wheeze in 9 cases (52.94%), sputum plugs in 8 cases (47.06%), hemoptysis in 5 cases (29.41%). Laboratory tests were as follows:peripheral blood eosinophil ratio in 14 cases increased, the average was (11.78 ± 7.93)%; the absolute value of peripheral blood eosinophils in 13 cases increased, the average was (10.95 ±0.71)*109/l; serum total IgE in all cases elevated, the average was (5391±4440.14) IU/ml; A. fumigates-specific IgE in all cases increased, the average was (31.37±25.86) KU/L; Aspergillus skin test in 16 cases was positive (1 case didn’t perform this test).17 patients took the pulmonary function test, FEV1 was (51.8±14.32)%, and FEV1 /forced vital capacity (FVC) was (54.45± 10.22)%. The imaging performances of HRCT were as follows:patchy infiltrates in 13 cases (76.47%), central bronchiectasis in 10 cases(58.82%), band liner opacities in 9 cases(52.94%), nodules in 5 cases(29.41%), mediastinal adenopathy in 7 cases(41.17%), mucus plug in 6 cases(35.29%), consolidation in 4 cases(23.52%), pleural thickening in 3 cases(17.65%). Treatment:10 patients took voriconazole and oral prednison e, and others only took oral prednisone.8 weeks later, clinical manifestations of all patients got moderate to significant remission:serum total IgE, eosinophil ratio, peripheral blood eosinophil count and A. fumigates-specific IgE decreased (P< 0.05); FEV1%and FEV1/FVC% significantly increased (P< 0.05). Imaging findings: After treatment, patchy infiltrates and nodules in 15 cases significantly reduced or even disappeared; one case developed permanent bronchial dilation; one case developed permanent pleuropulmonary fibrosis.Conclusion1. The clinical manifestations of ABPA is atypical and it is easy to be misdiagnosed. For patients with asthma complicated by chest imaging abnormalities, we should consider the possibility of ABPA. If necessary, take these examinations, such as fungal antigens skin prick test, serum total IgE, A. fumigates-specific IgE to improve the diagnosis.2. Diagnostic criteria of ABPA are complicated and difficult to perform, so it is recommended that we’d better simplify it. In order to make clinical application convenient, we propose a quasi diagnostic criterion of ABPA and the optimal follow-up system.3 Glucocorticoids combined with antifungal agents are recommended to treat ABPA, but there is no uniform therapeutic scheme about dose and course. Glucocorticoids combined with antifungal agents decreased total serum IgE, compared with glucocorticoids therapy alone.4. The levels of CEA in some patiens elevate. It is considerared that the elevation may be related to lung consolidation and local inflammation in the lung. With the improvement of pulmonary consolidation, the level of CEA decreased, too. |
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