Allergic bronchopulmonary aspergillosis - Lessons from 126 patients attending a chest clinic in north India
Allergic bronchopulmonary aspergillosis - Lessons from 126 patients attending a chest clinic in north India
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DOI：
10.1378/chest.130.2.442
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发表时间：
2006-08-01
期刊：
影响因子：
9.6
通讯作者：
Jindal, Surinder K.
中科院分区：
文献类型：
--
作者：
Agarwal, Ritesh;Gupta, Dheeraj;Jindal, Surinder K.
目的和目标：描述经验。筛选哮喘患者过敏性支气管肺曲菌病（ABPA）到胸部诊所。临床，血清学，放射学和治疗方面，包括ABPA的结果也进行了描述。方法：所有在胸部诊所连续就诊2年以上的哮喘患者均采用曲霉皮肤试验进行筛查。发现阳性的患者进一步调查ABPA。根据高分辨率CT表现，将患者随机分为ABPA-血清阳性（ABPA- s）、ABPA合并中枢性支气管扩张（ABPA- cb）和ABPA- cb合并其他影像学表现（ABPA- cb - orf）。结果：564例患者通过曲霉皮肤试验筛选；223例（39.5%）阳性，126例（27.2%）确诊为ABPA。ABPA-S 34例（27%），ABPA-CB 42例，ABPA-CB- orf 50例。59例患者（46.8%）曾接受过抗结核治疗。绝大多数患者就诊时均为支气管扩张。高衰减黏液嵌塞21例（16.7%）。ABPA的分期、病程、哮喘严重程度和血清学结果（即绝对嗜酸性粒细胞计数、IgE水平[总]和IgE水平[烟曲霉]）之间无显著差异。中位随访时间为13个月（范围9至38个月）。所有患者在6周时均进入“缓解期”。25名患者在治疗过程中“复发”。109名患者“完全缓解”，17名患者被归类为“糖皮质激素依赖性ABPA”，7名患者被归类为“终末期ABPA”。结论：本院哮喘患者ABPA发生率较高。这种疾病在印度仍未得到充分认识；绝大多数患者在发病时都有支气管扩张，几乎一半的患者最初被误诊为肺结核。有必要重新定义ABPA的定义和糖皮质激素治疗的最佳剂量/持续时间。本研究强调了对哮喘患者进行曲霉菌皮肤试验常规筛查的必要性。
Aims and objectives: To describe the experience. of screening patients with asthma for allergic bronchopulmonary aspergillosis (ABPA) presenting to a chest clinic. The clinical, serologic, radiologic, and treatment aspects including outcome of ABPA are also described.Methods: All consecutive patients with asthma presenting to the chest clinic over a period of 2 years were screened with an Aspergillus skin test. Patients who were found to be positive were further investigated for ABPA. Patients were also arbitrarily classified as ABPA-seropositive (ABPA-S), ABPA with central bronchiectasis (ABPA-CB), and ABPA-CB with other radiologic findings (ABPA-CB-ORF) based on the high-resolution CT findings.Results: Five hundred sixty-four patients were screened using an Aspergillus skin test; 223 patients (39.5%) were found to be positive, and ABPA was diagnosed in 126 patients (27.2%). There were 34 patients (27%) with ABPA-S, 42 patients with ABPA-CB, and 50 patients with ABPA-CB-ORF. Fifty-nine patients (46.8%) had received antitubercular therapy in the past. The vast majority of patients had bronchiectasis at presentation to our hospital. High-attenuation mucous impaction was noted in 21 patients (16.7%). There was no significant difference between the stages of ABPA and the duration of illness, the severity of asthma, and the serologic findings (ie, absolute eosinophil count, IgE levels [total] and IgE levels [for Aspergillus fumigatus]). The median duration of follow-up was 13 months (range, 9 to 38 months). All patients went into "remission" at 6 weeks. Twenty-five patients had a "relapse" during the course of their treatment. One hundred nine patients had "complete remission," 17 patients were classified as having "glucocorticoid-dependent ABPA," and 7 patients were classified as having "end-stage ABPA."Conclusions: There is a high prevalence of ABPA in asthmatic patients presenting at our hospital. The disease entity is still underrecognized in India; the vast majority of patients have bronchiectasis at presentation, and almost half are initially misdiagnosed as having pulmonary tuberculosis. There is a need to redefine the definitions of ABPA and the optimal dose/duration of glucocorticoid therapy. This study reinforces the need for the routine screening of asthmatic patients with an Aspergillus skin test.