Department of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
Chest. 2010 Jan;137(1):171-6. doi: 10.1378/chest.09-1103. Epub 2009 Jun 30.
The relevance of Aspergillus fumigatus in patients with cystic fibrosis (CF) not affected by allergic bronchopulmonary aspergillosis is unclear. Our aim was to determine the effect of persistent infection with A fumigatus on pulmonary exacerbations and lung function in children with CF.
This was a retrospective cohort study of patients with CF followed at The Hospital for Sick Children from 1999 to 2006. Persistent A fumigatus infection was defined as the presence of two or more positive sputum or bronchoalveolar cultures for A fumigatus in a given year. The primary outcome measure was the annual number of hospitalizations for pulmonary exacerbations.
Two hundred thirty patients with CF were included in the analysis. The FEV(1) of patients persistently infected with A fumigatus was 3.61% (P< or =.0001) lower during the study period compared with uninfected patients. There was a significant interaction between A fumigatus and Pseudomonas aeruginosa on lung function (P=.0006). Patients not infected with either organism had the highest pulmonary function. Persistent A fumigatus infection (relative risk [RR]=1.94, P=.0002) and CF-related diabetes (RR=1.64, P=.028) were associated with an increased risk of pulmonary exacerbations requiring hospitalization, whereas there was no increased risk of pulmonary exacerbations among patients with allergic bronchopulmonary aspergillosis (RR=1.02, P=.94). When adjusted for baseline pulmonary function, none of these variables were associated with a significantly increased risk of pulmonary exacerbations, with only chronic A fumigatus infection trending toward significance (RR=1.40, P=.065).
Persistent A fumigatus infection is an independent risk factor for hospital admissions in patients with CF.
变应性支气管肺曲霉病未受影响的囊性纤维化（CF）患者中烟曲霉的相关性尚不清楚。我们的目的是确定持续性烟曲霉感染对 CF 儿童肺部恶化和肺功能的影响。
这是一项回顾性队列研究，纳入了 1999 年至 2006 年在 SickKids 医院就诊的 CF 患者。持续性烟曲霉感染定义为当年两次或两次以上痰或支气管肺泡培养阳性。主要结局指标为因肺部恶化而住院的年次数。
共纳入 230 例 CF 患者进行分析。在研究期间，持续性烟曲霉感染患者的 FEV1 比未感染者低 3.61%（P<0.0001）。烟曲霉和铜绿假单胞菌之间存在显著的肺功能交互作用（P=.0006）。未感染这两种病原体的患者具有最高的肺功能。持续性烟曲霉感染（相对风险 [RR]=1.94，P=.0002）和 CF 相关糖尿病（RR=1.64，P=.028）与需要住院治疗的肺部恶化风险增加相关，而变应性支气管肺曲霉病患者的肺部恶化风险没有增加（RR=1.02，P=.94）。在调整基线肺功能后，这些变量均与肺部恶化风险显著增加无关，只有慢性烟曲霉感染呈增加趋势（RR=1.40，P=.065）。
持续性烟曲霉感染是 CF 患者住院的独立危险因素。
