关键词: 曲霉菌病, 变应性支气管肺；疾病特征；烟曲霉菌；症状和体征；支气管哮喘；结核, 肺；荟萃分析

Abstract: Background　Allergic bronchopulmonary aspergillosis （ABPA） is often misdiagnosed as asthma，tuberculosis，or other pulmonary diseases by clinicians due to lack of appropriate understanding of this disease.If not properly treated or untreated，ABPA may eventually progress into bronchiectasis and interstitial fibrosis，so early diagnosis and treatment is essential for patients with ABPA.However，available clinical studies about the natural course and treatment of ABPA are comparatively insufficient，and most of them are reports of sporadic cases，so there is a need of systematic summary of the disease.Objective　To summarize the clinical features of ABPA.Methods　We searched CHKD database for studies in Chinese published in General Core Journals of China （GCJC） （edited and published by the Peking University Library and University Library Journal Research Group of Beijing） as of May 2018 in which at least 10 cases of ABPA were reported with“变态反应性支气管肺曲菌病”“变应性支气管肺曲菌病”“过敏性支气管肺曲菌病”“ABPA”as the search terms.From the included studies，we extracted the used diagnostic criteria，and patients' general personal data，clinical manifestations，imaging features，laboratory test results，lung function status，method for identification of the pathogen，misdiagnoses，treatment and outcomes.Results　A total of 11 articles，involving 244 patients，were included.Among the patients，167 （68.4%） were diagnosed as ABPA associated with central bronchiectasis （ABPA-CB） and 77（31.6%） were serologically positive ABPA （ABPA-S）．The diagnosis was made based on the Rosenberg-Patterson 1977 criteria in 3 studies，Greenberger's simplified criteria in 3 studies，and 2008 IDSA practice guidelines for the diagnosis and management of aspergillus in 5 studies.The major clinical manifestations were cough （81.6%，199/244），wheezing （80.3%，188/234），and expectoration（78.7%，192/244）．The most common imaging features （mostly chest CT findings） were patchy shadow（83.5%，182/218），central bronchiectasis（74.2%，175/236），and fleeting infiltrations （47.7%，42/88）．Laboratory tests showed increased total IgE antibody levels in peripheral blood in 209 cases （98.6%，209/212），positive result of Aspergillus antigen skin test in 94 cases （95.9%，94/98），and elevated serum Aspergillus-specific IgE antibody in 147 cases （93.6%，147/157）．Identification of the pathogen was done by bronchoalveolar lavage fluid （BALF） smear or culture in 39 cases （45.3%，39/86），sputum smear or sputum culture in 80 cases （40.6%，80/197），fibrous bronchi microscopic biopsy or mucosal biopsy in 23 cases （23.7%，23/97）．62 cases were once misdiagnosed as bronchial asthma （50.4%，62/123），80 cases as tuberculosis （41.9%，80/191），and 54 cases as bacterial pneumonia（34.0%，54/159）．Most of the cases （82.1%，124/151） were treated mainly by oral glucocorticoid combined with antifungal therapy.Through regular treatment，most patients were relieved，and 185 cases of pulmonary lesions were reduced （82.8%，135/163），but 25 cases had recurrence and aggravation （29.8%，25/84）．Conclusion　Due to lack of specific clinical manifestations，ABPA is easily misdiagnosed and missed.When patients develop wheezing，cough，brown sticky sputum，increased peripheral blood eosinophils，obstructive ventilatory dysfunction，and have imaging features of central bronchiectasis，and a migrating patchy shadow in the lungs，ABPA should be vigilantly considered.

Key words: Aspergillosis, allergic bronchopulmonary；Disease attributes；Aspergillus fumigatus；Symptoms＆signs；Bronchial asthma；Tuberculosis, pulmonary；Meta analysis