Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria
Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria
复制标题
DOI：
10.1111/cea.12141
复制
发表时间：
2013-08-01
影响因子：
6.1
通讯作者：
Denning, D. W.
中科院分区：
文献类型：
--
作者：
Agarwal, R.;Chakrabarti, A.;Denning, D. W.
变应性支气管肺曲霉病（ABPA）是一种因对烟曲霉菌过敏而引起的免疫性肺部疾病，主要表现为哮喘控制不良、反复肺浸润和支气管扩张。据估计，全世界受影响的患者超过400万。认识ABPA的重要性与改善患者症状、延迟支气管扩张的发展或预防支气管扩张有关，支气管扩张是ABPA中永久性肺损伤的一种表现。环境因素可能不是唯一的致病因素，因为尽管暴露于相同的环境，但并非所有哮喘患者都会发展为ABPA。变应性支气管肺曲霉病可能是一种多基因疾病，一旦发病并不能完全缓解，但也可长期缓解。在遗传易感个体中，吸入A.烟曲霉萌发成菌丝，释放抗原，激活肺的先天性和适应性免疫应答（Th2 CD4（+）T细胞应答）。国际人类和动物真菌学会（ISHAM）成立了一个关于ABPA并发哮喘的工作组（www.abpaworkinggroup.org），该工作组召开了一次国际会议，总结了当前的知识状况，并制定了基于共识的诊断和治疗指南。提出了ABPA新的诊断和分期标准。虽然进行了少量的随机对照试验，但长期管理的研究仍然很少。主要治疗包括口服糖皮质激素以控制急性发作，伊曲康唑作为类固醇保留剂和优化的哮喘治疗。无争议地围绕着支气管扩张、慢性肺曲霉病和曲霉瘤并发症、并发鼻窦炎和环境控制的预防和管理。需要新的口服抗真菌药物和免疫调节治疗。
Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus, manifesting with poorly controlled asthma, recurrent pulmonary infiltrates and bronchiectasis. There are estimated to be in excess of four million patients affected world-wide. The importance of recognizing ABPA relates to the improvement of patient symptoms, and delay in development or prevention of bronchiectasis, one manifestation of permanent lung damage in ABPA. Environmental factors may not be the only pathogenetic factors because not all asthmatics develop ABPA despite being exposed to the same environment. Allergic bronchopulmonary aspergillosis is probably a polygenic disorder, which does not remit completely once expressed, although long-term remissions do occur. In a genetically predisposed individual, inhaled conidia of A. fumigatus germinate into hyphae with release of antigens that activate the innate and adaptive immune responses (Th2 CD4(+) T cell responses) of the lung. The International Society for Human and Animal Mycology (ISHAM) has constituted a working group on ABPA complicating asthma (www.abpaworkinggroup.org), which convened an international conference to summarize the current state of knowledge, and formulate consensus-based guidelines for diagnosis and therapy. New diagnosis and staging criteria for ABPA are proposed. Although a small number of randomized controlled trials have been conducted, long-term management remains poorly studied. Primary therapy consists of oral corticosteroids to control exacerbations, itraconazole as a steroid-sparing agent and optimized asthma therapy. Uncertainties surround the prevention and management of bronchiectasis, chronic pulmonary aspergillosis and aspergilloma as complications, concurrent rhinosinusitis and environmental control. There is need for new oral antifungal agents and immunomodulatory therapy.