Singh Meenu, Das Subhamoy, Chauhan Anil, Paul Nandini, Sodhi Kushaljit Singh, Mathew Joseph, Chakrabarti Arunaloke
Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Acta Paediatr. 2015 May;104(5):e206-9. doi: 10.1111/apa.12930. Epub 2015 Mar 13.
The aim of this study was to examine the association between allergic bronchopulmonary aspergillosis (ABPA) and poorly controlled asthma in children and appraise the diagnostic criteria.
The study included 100 children with poorly controlled asthma. We diagnosed ABPA using the Aspergillus skin test, pulmonary function test, total and specific immunoglobulin E (IgE) to Aspergillus fumigatus, chest radiograph and high-resolution computed tomography. Patients were diagnosed and classified according to the Rosenberg-Patterson criteria for ABPA. The cut-off value for total serum IgE was calculated by receiver operating characteristics curve analysis.
Of 100 children with poorly controlled asthma, 26 patients were ABPA positive. There was a significant difference in the forced expiratory volume in 1-sec/forced vital capacity ratio between ABPA positive (0.78 ± 0.14) and negative (0.87 ± 0.15) children (p = 0.008). ABPA positive children were categorised as seropositive, central bronchiectasis and other radiological findings. The receiver operating characteristics curve was constructed, and a value of 1200 IU/mL of total IgE was observed, with 88.5% sensitivity and 70.5% specificity.
This study showed an association between ABPA and poorly controlled asthma in children and suggests a higher cut-off value of total IgE for the diagnosis of ABPA.
本研究旨在探讨儿童变应性支气管肺曲霉病（ABPA）与控制不佳的哮喘之间的关联，并评估其诊断标准。
该研究纳入了100例控制不佳的哮喘儿童。我们通过曲霉皮肤试验、肺功能测试、针对烟曲霉的总免疫球蛋白E（IgE）和特异性IgE、胸部X线片以及高分辨率计算机断层扫描来诊断ABPA。根据ABPA的罗森伯格 - 帕特森标准对患者进行诊断和分类。通过受试者工作特征曲线分析计算血清总IgE的临界值。
在100例控制不佳的哮喘儿童中，26例ABPA呈阳性。ABPA阳性（0.78 ± 0.14）和阴性（0.87 ± 0.15）儿童之间的1秒用力呼气量/用力肺活量比值存在显著差异（p = 0.008）。ABPA阳性儿童被分类为血清阳性、中央型支气管扩张和其他影像学表现。构建了受试者工作特征曲线，观察到总IgE值为1200 IU/mL时，敏感性为88.5%，特异性为70.5%。
本研究表明儿童ABPA与控制不佳的哮喘之间存在关联，并提示诊断ABPA时总IgE的临界值应更高。
