Latzin P, Hartl D, Regamey N, Frey U, Schoeni M H, Casaulta C
Division of Respiratory Medicine, Dept of Paediatrics, University Children's Hospital of Bern, Inselspital, 3010 Bern, Switzerland.
Eur Respir J. 2008 Jan;31(1):36-42. doi: 10.1183/09031936.00078107. Epub 2007 Sep 26.
The diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) is a challenge. Thymus- and activation-regulated chemokine (TARC) has recently been reported to play a role in ABPA. The aim of this study was to compare the diagnostic value of TARC with that of known serological markers for diagnosis of ABPA in CF patients. The present study longitudinally followed 48 CF patients, of whom 12 had a diagnosis of ABPA according to Nelson's criteria, for 1-8 yrs with repeated measurements of serum total immunoglobulin (Ig)E, specific Aspergillus fumigatus IgE and IgG, specific IgE against recombinant A. fumigatus allergens (rAsp f) 1, 3, 4 and 6, and TARC. Median (interquartile range) TARC levels were 589 (465-673) pg x mL(-1) in ABPA patients and 232 (189-289) pg x mL(-1) in non-ABPA patients. Receiver operating characteristic curves revealed that TARC was superior to the other markers for diagnosis of ABPA. Diagnostic accuracy was greater for TARC (93%) than for total IgE (74%), or rAsp f 4 (75%) or f 6 (79%). The present study indicates that thymus- and activation-regulated chemokine may be useful in the diagnosis of allergic bronchopulmonary aspergillosis in cystic fibrosis patients. However, larger studies are needed before thymus- and activation-regulated chemokine can routinely be used in diagnostic algorithms.
诊断囊性纤维化（CF）患者的变应性支气管肺曲霉病（ABPA）颇具挑战。近期有报道称胸腺和活化调节趋化因子（TARC）在ABPA中发挥作用。本研究旨在比较TARC与已知血清学标志物对CF患者ABPA的诊断价值。本研究对48例CF患者进行了纵向随访，其中12例根据尼尔森标准诊断为ABPA，随访1 - 8年，期间多次测量血清总免疫球蛋白（Ig）E、烟曲霉特异性IgE和IgG、针对重组烟曲霉变应原（rAsp f）1、3、4和6的特异性IgE以及TARC。ABPA患者的TARC水平中位数（四分位间距）为589（465 - 673）pg x mL⁻¹，非ABPA患者为232（189 - 289）pg x mL⁻¹。受试者工作特征曲线显示，TARC在诊断ABPA方面优于其他标志物。TARC的诊断准确性（93%）高于总IgE（74%）、rAsp f 4（75%）或f 6（79%）。本研究表明，胸腺和活化调节趋化因子可能有助于诊断囊性纤维化患者的变应性支气管肺曲霉病。然而，在胸腺和活化调节趋化因子能够常规用于诊断算法之前，还需要开展更大规模的研究。
