慢性阻塞性肺疾病伴肺曲霉病诊治和管理专家共识
Expert consensus on the diagnosis and treatment of pulmonary aspergillosis in patients with chronic obstructive pulmonary disease
在慢性阻塞性肺疾病(简称慢阻肺)人群中,肺曲霉病的发病率不断上升,可表现为侵袭性感染、慢性肺曲霉病、变应性支气管肺曲霉病等多种形式;随着免疫功能等个体状态的变化,各种形式之间可互相转换甚至并存。同时,慢阻肺伴侵袭性肺曲霉病多缺乏典型表现,且部分患者有创检查受限,给诊断和治疗带来了挑战。为此,本共识基于循证证据和我国临床实践情况,对慢阻肺伴肺曲霉病诊治中的重要问题提出推荐意见,构建临床诊疗路径,期待为改善疾病管理提供参考和指引。
更多The prevalence of pulmonary aspergillosis is increasing in patients with chronic obstructive pulmonary disease (COPD) and can manifest in different forms such as invasive pulmonary aspergillosis (IPA), chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA). With the variations of individual conditions such as immune status, these forms of the disease may transform into each other or even overlap. Moreover, the atypical clinical manifestations and the limited use of invasive sampling techniques have posed a challenge to the diagnosis and treatment of invasive pulmonary aspergillosis in patients with COPD. To provide recommendations for the management of pulmonary aspergillosis in patients with COPD and to construct a clinical workflow, the consensus panel reviewed the evidence and critically appraised the existing studies. As the majority of the recommendations were supported by low levels of evidence, the evidence levels were not listed in the consensus and the strong and weak recommendations were expressed as “recommend” and “suggest”, respectively.
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