Assessment of Aspergillus sensitization or persistent carriage as a factor in lung function impairment in cystic fibrosis patients
Assessment of Aspergillus sensitization or persistent carriage as a factor in lung function impairment in cystic fibrosis patients
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DOI：
10.3109/00365548.2012.695454
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发表时间：
2012-11-01
影响因子：
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通讯作者：
Magnaval, Jean-Francois
中科院分区：
文献类型：
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作者：
Fillaux, Judith;Bremont, Francois;Magnaval, Jean-Francois
背景资料：囊性纤维化（CF）患者表现为持续携带烟曲霉菌或对烟曲霉菌致敏，通常采用抗真菌治疗，因为真菌的存在通常被认为会阻碍肺功能，即使在没有过敏性支气管肺曲霉菌病（ABPA）的情况下。本研究的目的是评估肺结核相关状态对CF患者1秒用力呼气量（FEV 1）的调节作用。方法：1995年至2007年，对251例患者进行了评估。记录人口统计学数据、囊性纤维化跨膜传导调节基因（CFTR）突变、体重指数和FEV 1。A.痰液中烟曲霉菌和铜绿假单胞菌的含量及A.烟曲霉沉淀素、总IgE（t-IgE）和特异性抗A.烟曲霉IgE（Af-IgE）测定。将患者分为3组：（1）ABPA组：A.烟曲霉沉淀素≥ 3行，Af-IgE > 0.35 IU/ml，t-IgE ≥ 500 IU/ml;（2）致敏：Af-IgE > 0.35 IU/ml，但t-IgE < 500 IU/ml;（3）持续携带：Af-IgE ≥ 3行，前提是已发现该血清学发现与至少1种A相关。烟曲霉阳性培养。其余患者为对照组。以FEV 1为结局变量进行多因素分析。结果如下：与对照组相比，ABPA、致敏和持续携带与FEV 1的较大下降显著相关，比值比分别为15.9、14.9和10.7。这种关联与其他相关因素（铜绿假单胞菌一过性检测、年龄、体重过轻和基线时FEV 1较低）无关。结论：除了ABPA，致敏和持续携带似乎对CF患者的肺功能有影响。
Background: Cystic fibrosis (CF) patients presenting with persistent carriage of, or sensitization to, Aspergillus fumigatus are often treated with antifungal therapies because the presence of the fungus is commonly thought to impede lung function, even in the absence of allergic bronchopulmonary aspergillosis (ABPA). The aim of this study was to assess Aspergillus-related status modulating the forced expiratory volume in 1 s (FEV1) of CF patients. Methods: From 1995 to 2007, 251 patients were evaluated. Demographic data, cystic fibrosis transmembrane conductance regulator gene (CFTR) mutations, body mass index, and FEV1 were recorded. The presence of A. fumigatus and Pseudomonas aeruginosa in sputum and the levels of A. fumigatus precipitin, total IgE (t-IgE), and specific anti-A. fumigatus IgE (Af-IgE) were determined. Patients were divided into 3 groups: (1) ABPA: A. fumigatus precipitin >= 3 lines, Af-IgE > 0.35 IU/ml, and t-IgE >= 500 IU/ml; (2) sensitization: Af-IgE > 0.35 IU/ml but t-IgE < 500 IU/ml; and (3) persistent carriage: Af-IgE = 3 lines, provided this serological finding had been found associated with at least 1 A. fumigatus-positive culture. The remaining patients represented the control group. A multivariate analysis was carried out with FEV1 as the outcome variable. Results: ABPA, sensitization, and persistent carriage were significantly associated with a larger decline in FEV1 compared with the control group, with odds ratios of 15.9, 14.9, and 10.7, respectively. This association was independent of other associated factors (P. aeruginosa transient detection, age, being underweight, and low FEV1 at baseline). Conclusions: In addition to ABPA, sensitization and persistent carriage appear to have an impact on pulmonary function in CF patients.