New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation
New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation
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DOI：
10.1016/j.jaci.2020.08.029
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发表时间：
2021-04-05
影响因子：
14.2
通讯作者：
Oguma, Tsuyoshi
中科院分区：
文献类型：
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作者：
Asano, Koichiro;Hebisawa, Akira;Oguma, Tsuyoshi
背景：变应性支气管肺曲霉病（ABPA）有几种临床诊断标准。然而，这些标准尚未得到详细的验证，目前也没有过敏性支气管肺真菌病（ABPM）的标准。目的：提出由10个组分组成的ABPA/ABPM新诊断标准，并比较其与现有方法的敏感性和特异性。方法：采用1977年提出的Rosenberg-Patterson标准和2013年提出的ISHAM （International Society for Human and Animal真菌学）标准，将79例病理性ABPM和无真菌菌丝的变应性粘蛋白对照人群（n = 37）、慢性嗜酸性肺炎（n = 64）、曲霉致敏性重度哮喘（n = 26）、慢性肺曲霉病（n = 24）应用该新标准。这些标准也适用于日本全国调查中179例医生诊断为ABPA/ABPM的病例。结果：罗森伯格-帕特森标准、ISHAM标准和新标准对病理性ABPM的敏感性分别为25.3%、77.2%和96.2%。医师诊断的ABPA/ABPM的敏感性分别为49.2%、82.7%和94.4%。受者-工作特征曲线下面积分别为0.85、0.90和0.98。非曲霉真菌培养阳性的ABPM病例敏感性分别为13.0%、47.8%和91.3%。结论：与现有诊断标准相比，新诊断标准对ABPA/ABPM的诊断具有更好的敏感性和特异性。
Background: There are several clinical diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA). However, these criteria have not been validated in detail, and no criteria for allergic bronchopulmonary mycosis (ABPM) are currently available.Objective: This study proposes new diagnostic criteria for ABPA/ABPM, consisting of 10 components, and compares its sensitivity and specificity to existing methods.Methods: Rosenberg-Patterson criteria proposed in 1977, the International Society for Human and Animal Mycology (ISHAM) criteria proposed in 2013, and this new criteria were applied to 79 cases with pathological ABPM and the control population with allergic mucin in the absence of fungal hyphae (n = 37), chronic eosinophilic pneumonia (n = 64), Aspergillus-sensitized severe asthma (n = 26), or chronic pulmonary aspergillosis (n = 24). These criteria were also applied to the 179 cases with physician-diagnosed ABPA/ABPM in a nationwide Japanese survey.Results: The sensitivity for pathological ABPM with Rosenberg-Patterson criteria, ISHAM criteria, and this new criteria were 25.3%, 77.2%, and 96.2%, respectively. The sensitivity for physician-diagnosed ABPA/ABPM were 49.2%, 82.7%, and 94.4%, respectively. The areas under the curve for the receiver-operating characteristic curves were 0.85, 0.90, and 0.98, respectively. The sensitivity for ABPM cases that were culture-positive for non-Aspergillus fungi were 13.0%, 47.8%, and 91.3%, respectively.Conclusions: The new diagnostic criteria, compared with existing criteria, showed better sensitivity and specificity for diagnosing ABPA/ABPM.