| BackgroundFungi are widely exist in the surrounding environment and can cause hypersensitivity in the airway as inhalant allergens,including fungal allergic bronchitis,severe asthma with fungal sensitization(SAFS),allergic brochopulmonary mycosis(ABPM),etc.Aspergillus is the most widely distributed fungus in nature.Allergic lung disease caused by Aspergillus fumigatus sensitization is called allergic brochopulmonary aspergillosis(ABPA).ABPA is common in patients with bronchial asthma and cystic fibrosis(CF),This disease is relatively rare and lacks specificity in clinical manifestations.It is easy to be misdiagnosed or never diagnosed at an early stage.If early diagnosis and treatment cannot be achieved,the disease is prone to recurrence,eventually causing irreversible damage to the lung structure and affecting the quality of patients.ObjectiveThis study summarized the clinical characteristics of ABPA by analyzing the general information,clinical features,laboratory examinations,chest imaging examinations,pulmonary function,bronchoscopy,treatment,and follow-up of ABPA patients.Deepen the understanding of ABPA by clinicians,so as to achieve early diagnosis,early treatment and avoid irreversible damage to the lung structure.MethodsRetrospective analysis of patients diagnosed with ABPA in the Department of Respiratory Medicine of the First Affiliated Hospital of Zhengzhou University from September 2016 to September 2019.A total of 75 patients were included according to the inclusion and exclusion criteria.To summarize its clinical characteristics by analyzing general information such as gender,age,white blood cell count,eosinophils(EOS)ratio,absolute eosinophils,serum total immunoglobulin E(IgE),Aspergillus fumigatus specific IgE and other serological indicators,pulmonary function,chest imaging and other related examinations.After discharge,29 patients were treated with oral glucocorticoid and 46 patients were treated with antifungal drug combined with glucocorticoid.After 2 months of treatment,the clinical efficacy was evaluated by comparing laboratory indicators and chest imaging changes.Data analysis was performed using SPSS21.0 statistical software.Results1.General information:75 patients with ABPA,47 males and 28 females,with an average age of(44.1±13.3)years.Before diagnosis of ABPA,22 patients were diagnosed with bronchial asthma,5 with chronic obstructive pulmonary disease,7 with diabetes,11 with allergic rhinitis and 2 with sinusitis;17 were misdiagnosed as bronchiectasis,11 as lung infection,5 as eosinophilic pneumonia,6 as tuberculosis,and 1 as lung cancer.2.Clinical manifestations:73 cases of cough,71 cases of sputum,56 cases of wheezing,8 cases of sputum plug,8 cases of fever,11 cases of chest pain,5 cases of hemoptysis and 4 cases of dyspnea;The wheezing sound were heard in 59 patients and wet rales were heard in 10 patients,wheezing and wet rales were heard in 8 patients.3.Serological examination and chest HRCT manifestations:75 patients had increased total IgE level[median 4714.00(2732.00,5000.00)IU/ml];The peripheral blood eosinophil counts were increased in 69 patients[median 0.93(0.72,1-68)×109/L]and percentages of peripheral blood eosinophil were elevated to(14.75±7.93)%;Skin prink test was positive in 57 cases;75 patients had increased Aspergillus fumigatus specific IgE[median 10.2(2.90,18.60)KU/L);Chest HRCT showed multiple pachy and flocculent exudates in 59 cases,central cylindrical bronchiectasis in 55 cases,consolidation in 27 cases,band linear in 22 cases,band liner opacities in 20 cases,mucous plugging in 18 cases,mediastinal adenopathy in 14 cases,nodules in 12 cases,pleural thickening in 8 cases.4.Treatment:46 patients were treated with oral glucocorticoid combined with antifungal drugs,and 29 patients were treated with oral glucocorticoid.After 2 months of treatment,the total serum IgE,the count of peripheral blood EOS,and the percentages of peripheral blood EOS were significantly lower than before(P<0.05),and Aspergillus fumigatus-specific IgE did not decrease significantly(P>0.05).Compared with oral glucocorticoid therapy alone,antifungal drug combined with oral glucocorticoid therapy showed a more significant decrease in total serum IgE,peripheral blood eosinophil counts,the percentages of peripheral blood eosinophil and chest radiographic absorption(P<0.05),and there was no significant decrease in Aspergillus fumigatus-specffic IgE(P>0.05).Conclusions1.The ABPA lacks specificity in clinical manifestations,It is easy to be misdiagnosed and mised at an early stage.2.It is recommended that fungal antigens skin prick test or A.fumigates-specific IgE be detected as early as possible to improve the diagnosis in some suspicious patients such as asthma,CF,bronchiectasis,COPD with elevated eosinophils and recurrent cough,sputum,wheezing.3.Antifungal drugs combined with oral-glucocorticoid are more effective than oral glucocorticoid alone,which can reduce relapse and improve prognosis. |
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