Agarwal R, Aggarwal A N, Gupta D, Jindal S K
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Int J Tuberc Lung Dis. 2009 Aug;13(8):936-44.
The prevalence of Aspergillus hypersensitivity (AH) and allergic bronchopulmonary aspergillosis (ABPA) in bronchial asthma is reported differently in various studies.
To determine the prevalence of AH and ABPA in asthma using a systematic review.
We searched the MEDLINE and EMBASE databases for studies published from 1965 to 2008 and included studies that report the prevalence of AH/ABPA in asthma. We calculated the proportions with 95% confidence interval (CI) to assess the prevalence of AH/ABPA in the individual studies and pooled the results using a random effects model.
Our search yielded 21 eligible studies. The prevalence of AH in bronchial asthma was 28% (95%CI 24-34), and was higher with an intradermal test vs. a prick test (28.7% vs. 24.8%, P = 0.002), but did not vary with the type of antigen used (indigenous or commercial). The prevalence of ABPA in bronchial asthma and Aspergillus-hypersensitive bronchial asthma was respectively 12.9% (95%CI 7.9-18.9) and 40% (95%CI 27-53). There was a wide variation in the criteria used for the diagnosis of ABPA. There was significant statistical heterogeneity assessed by the I(2) test and Cochran Q statistic in all the outcomes.
There is a high prevalence of AH and ABPA in patients with bronchial asthma. Careful screening should therefore be performed in all patients with bronchial asthma. Intradermal tests are more sensitive than prick tests for the diagnosis of AH. Finally, there is a need to adopt a uniform methodology and criteria for the diagnosis of AH/ABPA.
在支气管哮喘中，曲霉菌超敏反应（AH）和变应性支气管肺曲霉菌病（ABPA）的患病率在不同研究中的报道有所不同。
通过系统评价确定哮喘中AH和ABPA的患病率。
我们检索了MEDLINE和EMBASE数据库中1965年至2008年发表的研究，并纳入了报告哮喘中AH/ABPA患病率的研究。我们计算了95%置信区间（CI）的比例，以评估各研究中AH/ABPA的患病率，并使用随机效应模型汇总结果。
我们的检索产生了21项符合条件的研究。支气管哮喘中AH的患病率为28%（95%CI 24 - 34），皮内试验的患病率高于点刺试验（28.7%对24.8%，P = 0.002），但不随所用抗原类型（本土或商用）而变化。支气管哮喘和曲霉菌超敏性支气管哮喘中ABPA的患病率分别为12.9%（95%CI 7.9 - 18.9）和40%（95%CI 27 - 53）。ABPA诊断所用标准存在很大差异。所有结果经I(2)检验和Cochran Q统计量评估均存在显著的统计学异质性。
支气管哮喘患者中AH和ABPA的患病率较高。因此，应对所有支气管哮喘患者进行仔细筛查。皮内试验在诊断AH方面比点刺试验更敏感。最后，需要采用统一的方法和标准来诊断AH/ABPA。
