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

摘要： 背景　由于临床医生认识不足，变态反应性支气管肺曲菌病（ABPA）常被误诊为支气管哮喘和肺结核等疾病，不经治疗或治疗不恰当最终将发展为支气管扩张和肺间质纤维化，所以对ABPA做到早期诊断和治疗非常重要。但目前有关ABPA自然病程和治疗的临床研究比较缺乏，文献也多为散在的临床病例报道，缺乏对该疾病系统的总结。目的　总结ABPA的临床特征。方法　以“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”为检索词，通过中国医院知识数据库（CHKD）对2018年5月以前发表的例数达10例及以上且发表在北大中文核心期刊的中文文献进行检索，并提取一般资料、诊断标准、临床表现、影像学特点、实验室检查、肺功能检查、病原学确诊方法、误诊情况、治疗及转归等信息。结果　共纳入文献11篇，计244例患者。244例患者中，ABPA伴中心性支气管扩张型（ABPA-CB）167例（68.4%），血清学阳性ABPA（ABPA-S）77例（31.6%）。3篇文献采用1977年Rosenberg诊断标准，3篇文献采用Greenberger简化的5条诊断标准，5篇文献采用2008年美国感染病学会制定的曲霉菌诊治指南。ABPA主要临床表现有咳嗽199例（81.6%，199/244），喘息188例（80.3%，188/234），咳痰192例（78.7%，192/244）。影像学（主要是胸部CT）最常见的表现为斑片状影182例（83.5%，182/218），中心性支气管扩张175例（74.2%，175/236），病原呈游走性42例（47.7%，42/88）。实验室检查主要有外周血总IgE抗体水平升高209例（98.6%，209/212），曲霉菌皮肤变应原检测阳性94例（95.9%，94/98），血清烟曲霉菌特异性IgE抗体升高147例（93.6%，147/157）。病原学检查方法主要是支气管肺泡灌洗液（BALF）涂片或培养阳性39例（45.3%，39/86），痰涂片或痰培养阳性80例（40.6%，80/197），纤维支气管镜肺活检或黏膜活检23例（23.7%，23/97）。误诊为支气管哮喘62例（50.4%，62/123），肺结核80例（41.9%，80/191），细菌性肺炎54例（34.0%，54/159）。治疗主要以口服糖皮质激素联合抗真菌治疗124例（82.1%，124/151），通过正规治疗，多数患者病情缓解，肺部病变吸收减少135例（82.8%，135/163）；25例（29.8%，25/84）患者病情反复加重。结论　ABPA临床表现缺乏特异性，极易误诊和漏诊；当患者出现喘息、咳嗽、咳棕褐色黏冻样痰栓、外周血嗜酸粒细胞升高、肺功能显示阻塞性通气功能障碍、影像学表现为中心性支气管扩张、肺内游走斑片状影时，应高度警惕ABPA。

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