Burgel Pierre-Régis, Paugam André, Hubert Dominique, Martin Clémence
Department of Respiratory Medicine, Cochin Hospital, Assistance Publique - Hôpitaux de Paris; Université Paris Descartes, Sorbonne Paris Cité.
Université Paris Descartes, Sorbonne Paris Cité; Parasitology-Mycology Laboratory, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Infect Drug Resist. 2016 Sep 20;9:229-238. doi: 10.2147/IDR.S63621. eCollection 2016.
is the main fungus cultured in the airways of patients with cystic fibrosis (CF). Allergic bronchopulmonary aspergillosis occurs in ~10% of CF patients and is clearly associated with airway damage and lung function decline. The effects of colonization in the absence of allergic bronchopulmonary aspergillosis are less well established. Retrospective clinical studies found associations of -positive cultures with computed tomography scan abnormalities, greater risk of CF exacerbations and hospitalizations, and/or lung function decline. These findings were somewhat variable among studies and provided only circumstantial evidence for a role of colonization in CF lung disease progression. The availability of a growing number of oral antifungal triazole drugs, together with the results of nonrandomized case series suggesting positive effects of azole therapies, makes it tempting to treat CF patients with these antifungal drugs. However, the only randomized controlled trial that has used itraconazole in CF patients showed no significant benefit. Because triazoles may have significant adverse effects and drug interactions, and because their prolonged use has been associated with the emergence of azole-resistant isolates, it remains unclear whether or not CF patients benefit from azole therapy.
是囊性纤维化（CF）患者气道中培养出的主要真菌。变应性支气管肺曲霉病发生在约10%的CF患者中，且与气道损伤和肺功能下降明显相关。在无变应性支气管肺曲霉病的情况下，其定植的影响尚不明确。回顾性临床研究发现，阳性培养结果与计算机断层扫描异常、CF病情加重和住院风险增加以及/或肺功能下降有关。这些研究结果在不同研究中有所差异，仅提供了曲霉定植在CF肺部疾病进展中起作用的间接证据。越来越多的口服抗真菌三唑类药物可供使用，以及非随机病例系列结果表明唑类疗法有积极作用，这使得人们倾向于用这些抗真菌药物治疗CF患者。然而，唯一一项在CF患者中使用伊曲康唑的随机对照试验未显示出显著益处。由于三唑类可能有显著的不良反应和药物相互作用，且其长期使用与唑类耐药曲霉分离株的出现有关，CF患者是否能从唑类治疗中获益仍不清楚。
