Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Mycopathologia. 2012 Sep;174(3):193-201. doi: 10.1007/s11046-012-9535-x. Epub 2012 Mar 29.
The association between allergic bronchopulmonary aspergillosis (ABPA) and aspergilloma has been proposed as a severe form of ABPA. However, this conclusion is based on single-patient case reports. In this study, we describe the clinical details and immunological findings of this association and compare patients of ABPA with aspergilloma and those without.
This is a retrospective analysis of data of patients with ABPA managed in the Chest Clinic. We compared the clinical, radiological and immunological profile of patients with ABPA and central bronchiectasis, with and without the presence of aspergilloma on HRCT scan.
There were 98 men and 81 women with a mean (SD) age of 33.6 (12.2) years. Eight patients were diagnosed to have aspergilloma. Sputum cultures grew Aspergillus fumigatus in all these eight patients. The aspergilloma was solitary in six patients, and two each in two patients. Patients with aspergilloma had higher IgE levels (both total and A. fumigatus specific) than those without aspergilloma. Bronchiectasis was also more extensive in patients with aspergilloma. Overall, 70 % of the ABPA patients experienced relapse during the median (interquartile range) follow-up of 27 (19-39) months. The number of relapses was significantly higher in patients with aspergilloma (p = 0.0001). On a multivariate linear regression analysis, high-attenuation mucus and aspergilloma were independent predictors of relapse frequency.
The concurrent presentation of ABPA and aspergilloma is associated with an immunologically severe disease and risk of recurrent relapses.
过敏性支气管肺曲霉病（ABPA）与曲霉球之间的关联被认为是 ABPA 的一种严重形式。然而，这一结论是基于单一患者的病例报告。在本研究中，我们描述了这种关联的临床细节和免疫学发现，并比较了 ABPA 合并曲霉球与不合并曲霉球患者的临床、影像学和免疫学特征。
这是对在胸科诊所接受 ABPA 治疗的患者数据进行的回顾性分析。我们比较了 HRCT 扫描显示存在或不存在中央支气管扩张时，ABPA 合并中央支气管扩张与单纯 ABPA 患者的临床、影像学和免疫学特征。
共纳入 98 例男性和 81 例女性患者，平均（SD）年龄为 33.6（12.2）岁。8 例患者被诊断为曲霉球。所有这 8 例患者的痰培养均生长烟曲霉。6 例患者的曲霉球为单发，2 例患者各有 2 个。合并曲霉球的患者的 IgE 水平（总 IgE 和烟曲霉特异性 IgE）均高于无曲霉球的患者。合并曲霉球的患者支气管扩张也更为广泛。总的来说，70%的 ABPA 患者在中位（27（19-39）个月）随访期间出现复发。合并曲霉球的患者复发次数明显更多（p=0.0001）。多元线性回归分析显示，高衰减黏液和曲霉球是复发频率的独立预测因素。
ABPA 与曲霉球同时存在与免疫严重程度相关，并与复发性疾病的风险增加相关。
