Wark P, Wilson A W, Gibson P G
Department of Respiratory Medicine, John Hunter Hospital, Locked Bag No 1, Hunter Region Mail Centre, NSW, Australia, 2310.
Cochrane Database Syst Rev. 2001(4):CD001108. doi: 10.1002/14651858.CD001108.
Allergic Broncho-pulmonary Aspergillosis is hypersensitivity to the fungus Aspergillus fumigatus that complicates patients with asthma and cystic fibrosis. The mainstay of treatment for ABPA remains oral corticosteroids, though this does not completely prevent exacerbations and may not prevent the decline in lung function.
The purpose of this review was to determine the efficacy of azoles in the treatment of Allergic Broncho-pulmonary Aspergillosis.
The Cochrane Airways Group Asthma register was searched using the terms: (allergic bronchopulmonary aspergillosis OR aspergillosis OR allergic pulmonary aspergillosis OR allergic fungal and disease OR allergic mycotic and disease) AND (azole OR triazole OR itraconazole OR ketoconazole).
All controlled trials that assessed the effect of azole antifungal agents compared to placebo or other standard therapy for ABPA were reviewed. Patients with cystic fibrosis were not included.
All identified trials were independently reviewed by both reviewers & all data collected. Trial quality was scored by the Cochrane assessment of allocation concealment & the Jadad scale of methodological quality.
Twelve trials were identified, but only three were prospective, randomised and controlled. One demonstrated a reduction in immunological markers of disease activity and symptom scores using ketoconazole 400 mg daily for 12 month. There was no significant improvement in lung function. The other two examined the use of itraconazole for 16 weeks. In one there was a reduction in sputum eosinophils by 35% compared to 19% with placebo (p<0.01). In the same trial, the number of exacerbations requiring oral corticosteroids was 0.4 per patient with itraconazole compared with 1.3 per patient with placebo (p<0.03). Meta analysis of data from both trials showed that itraconazole treated patients were more likely to have decline in serum IgE over 25% or more (Odds Ratio 3.3; 95% confidence intervals 1.3, 8.2).
REVIEWER'S CONCLUSIONS: Itraconazole modifies the immunologic activation associated with ABPA and improves clinical outcome in ABPA at least over the period of 16 weeks.
变应性支气管肺曲霉病是对烟曲霉的超敏反应，常使哮喘和囊性纤维化患者病情复杂化。变应性支气管肺曲霉病的主要治疗方法仍然是口服糖皮质激素，尽管这并不能完全预防病情加重，也可能无法阻止肺功能下降。
本综述的目的是确定唑类药物治疗变应性支气管肺曲霉病的疗效。
使用以下检索词检索Cochrane Airways Group哮喘注册库：（变应性支气管肺曲霉病或曲霉病或变应性肺曲霉病或变应性真菌病或变应性霉菌病）以及（唑类或三唑类或伊曲康唑或酮康唑）。
对所有评估唑类抗真菌药物与安慰剂或其他变应性支气管肺曲霉病标准治疗方法相比疗效的对照试验进行综述。不纳入囊性纤维化患者。
两位综述作者独立审查所有识别出的试验并收集所有数据。试验质量通过Cochrane分配隐藏评估和Jadad方法学质量量表进行评分。
共识别出12项试验，但只有3项是前瞻性、随机对照试验。其中一项试验表明，每日服用400mg酮康唑12个月可降低疾病活动的免疫标志物和症状评分。肺功能无显著改善。另外两项试验研究了伊曲康唑16周的使用情况。其中一项试验中，与安慰剂组（19%）相比，伊曲康唑组痰嗜酸性粒细胞减少了35%（p<0.01）。在同一试验中，伊曲康唑组每位患者需要口服糖皮质激素治疗的病情加重次数为0.4次，而安慰剂组为1.3次（p<0.03）。对两项试验数据的荟萃分析表明，接受伊曲康唑治疗的患者血清IgE下降超过25%或更多的可能性更大（比值比3.3；95%置信区间1.3, 8.2）。
伊曲康唑可改变与变应性支气管肺曲霉病相关的免疫激活，并至少在16周内改善变应性支气管肺曲霉病的临床结局。
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