University Lille Nord de France, University Hospital Centre, IFR, Institut Pasteur de Lille, France.
Med Mycol. 2010 Nov;48 Suppl 1:S77-87. doi: 10.3109/13693786.2010.514301.
Allergic bronchopulmonary aspergillosis (ABPA), which results from hypersensitivity, primarily to Aspergillus, represents a severe complication in patients suffering from asthma or cystic fibrosis (CF). Since early treatment of ABPA is supposed to prevent long-term damages, ABPA has to be diagnosed promptly. However, this diagnosis is not straightforward due to clinical and radiological features of ABPA overlapping with those of CF. Despite ABPA specific diagnosis criteria proposed by the Cystic Fibrosis Foundation in 2003, making a definitive ABPA diagnosis in CF patients remains a challenge. Recent advances in the immunopathogenesis of ABPA have initiated the development of new serological tests, such as the recently reported detection of specific IgE to recombinant A. fumigatus allergens, or Thymus- and activation-regulated chemokine (TARC / CCL17), both of which are of value in the diagnosis of APBA. We review in this paper the serum markers that can advance ABPA diagnosis in CF patients, ranging from the well known criteria (anti-A. fumigatus IgE, IgG, and precipitins) to the recent biomarkers (IgE towards recombinant A. fumigatus allergens or TARC detection). Taking into account the up-dated physiopathology of ABPA, we discuss their place and their usefulness, especially TARC, to improve early ABPA detection and monitoring in CF patients.
变应性支气管肺曲霉病（ABPA）是由对曲霉属的过敏反应引起的，主要发生在哮喘或囊性纤维化（CF）患者中，是一种严重的并发症。由于早期治疗 ABPA 可预防长期损害，因此应迅速诊断 ABPA。然而，由于 ABPA 的临床和放射学特征与 CF 的重叠，因此诊断并不简单。尽管囊性纤维化基金会在 2003 年提出了 ABPA 的特定诊断标准，但在 CF 患者中做出明确的 ABPA 诊断仍然具有挑战性。ABPA 免疫发病机制的最新进展促使新的血清学检测方法的发展，例如最近报道的对重组烟曲霉过敏原的特异性 IgE 的检测，或胸腺和激活调节趋化因子（TARC/CCL17），两者在 APBA 的诊断中都具有价值。我们回顾了在 CF 患者中可推进 ABPA 诊断的血清标志物，范围从众所周知的标准（抗烟曲霉 IgE、IgG 和沉淀素）到最近的生物标志物（对重组烟曲霉过敏原的 IgE 或 TARC 检测）。考虑到 ABPA 的更新生理病理学，我们讨论了它们的位置和用途，特别是 TARC，以提高 CF 患者中 ABPA 的早期检测和监测。
