IgE Sensitization to Aspergillus fumigatus Is Associated with Reduced Lung Function in Asthma
IgE Sensitization to Aspergillus fumigatus Is Associated with Reduced Lung Function in Asthma
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DOI：
10.1164/rccm.201001-0087oc
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发表时间：
2010-12-01
影响因子：
24.7
通讯作者：
Pashley, Catherine H.
中科院分区：
文献类型：
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作者：
Fairs, Abbie;Agbetile, Joshua;Pashley, Catherine H.
原理：烟曲霉致敏以及在哮喘患者气道内定植的重要性尚不明确。
目的：明确与烟曲霉相关的哮喘的临床和实验室特征之间的关系。
方法：我们研究了79例哮喘患者（89%被归类为全球哮喘防治创议[GINA]4级或5级），根据对烟曲霉的致敏情况将其分为3组：（1）IgE致敏组（皮肤即刻反应性>3mm和/或IgE>0.35kU/L）；（2）仅IgG致敏组（IgG>40mg/L）；（3）非致敏组。将这些患者与14名健康对照者进行比较。痰培养着重于检测烟曲霉，并与临床评估数据进行比较。
测量及主要结果：从63%的IgE致敏哮喘患者（n = 40）、39%的仅IgG致敏哮喘患者（n = 13）、31%的非致敏哮喘患者（n = 26）以及7%的健康对照者（n = 14）中培养出烟曲霉。与非致敏哮喘患者相比，对烟曲霉致敏的患者肺功能更低（支气管扩张剂使用后预计用力呼气容积1秒[FEV1]百分比，均值[标准误]：68[±5]%对88[±5]%；P<0.05），支气管扩张更多（68%对35%；P<0.05），痰中性粒细胞更多（中位数[四分位间距]：80.9[50.1 - 94.1]%对49.5[21.2 - 71.4]%；P<0.01）。在一个多元线性回归模型中，烟曲霉 - IgE致敏和痰中性粒细胞分类计数是肺功能的重要预测因子（P = 0.016），这得到了烟曲霉培养（P = 0.046）和嗜酸性粒细胞分类计数（P = 0.024）的支持。
结论：痰中检测到烟曲霉与烟曲霉 - IgE致敏、中性粒细胞性气道炎症以及肺功能降低相关。这支持了哮喘中固定性气流受限的发展是由于烟曲霉在气道定植的损害作用所导致的这一概念。
Rationale: The importance of Aspergillus fumigatus sensitization and colonization of the airways in patients with asthma is unclear. Objectives: To define the relationship between the clinical and laboratory features of A. fumigatus-associated asthma.Methods: We studied 79 patients with asthma(89% classed as GINA4 or 5) classified into 3 groups according to A. fumigatus sensitization: (1) IgE-sensitized (immediate cutaneous reactivity > 3 mm and/or IgE > 0.35 kU/L); (2) IgG-only-sensitized (IgG > 40 mg/L); and (3) nonsensitized. These were compared with 14 healthy control subjects. Sputum culture was focused toward detection of A. fumigatus and compared with clinical assessment data.Measurements and Main Results: A. fumigatus was cultured from 63% of IgE-sensitized patients with asthma (n = 40), 39% of IgG-only-sensitized patients with asthma (n = 13), 31% of nonsensitized patients with asthma (n = 26) and 7% of healthy control subjects (n = 14). Patients sensitized to A. fumigatus compared with nonsensitized patients with asthma had lower lung function (postbronchodilator FEV1 % predicted, mean [SEM]: 68 [+/- 5]% versus 88 [+/- 5]%; P < 0.05), more bronchiectasis (68% versus 35%; P < 0.05), and more sputum neutrophils (median [interquartile range]: 80.9 [50.1-94.1]% versus 49.5 [21.2-71.4]%; P < 0.01). In a multilinear regression model, A. fumigatus-IgE sensitization and sputum neutrophil differential cell count were important predictors of lung function (P = 0.016), supported by culture of A. fumigatus (P = 0.046) and eosinophil differential cell count (P = 0.024).Conclusions: A. fumigatus detection in sputum is associated with A. fumigatus-IgE sensitization, neutrophilic airway inflammation, and reduced lung function. This supports the concept that development of fixed airflow obstruction in asthma is consequent upon the damaging effects of airway colonization with A. fumigatus.