Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Clin Microbiol Infect. 2019 Sep;25(9):1157.e1-1157.e7. doi: 10.1016/j.cmi.2019.01.007. Epub 2019 Jan 25.
The treatment response in chronic pulmonary aspergillosis (CPA) is usually assessed based on the improvement in clinical and imaging findings. Herein, we evaluate serum Aspergillus fumigatus-specific IgG, serum galactomannan, weight change, and lung function for assessing treatment response in subjects with CPA.
We categorized treatment response as favourable (improved or stable clinical response with radiologically improved or stable disease) or unfavourable (worsening of symptoms or radiological progression) after 6 months of treatment with antifungal azoles. We measured A. fumigatus-specific IgG, serum galactomannan, weight, and lung function at baseline, 3 months, and 6 months in those with favourable and unfavourable treatment response.
One hundred and twenty-six consecutive treatment-naïve subjects (53.2% (67/126) males; mean ± SD age, 42.3 ± 14.7 years) with CPA were included. One hundred and six and 20 were classified as having favourable and unfavourable response, respectively. After 6 months of treatment, the decline in serum A. fumigatus-specific IgG (n = 119) was similar in those with favourable or unfavourable response (mean ± SD, -26.3 ± 45.5 mgA/L vs. -3.4 ± 65.6 mgA/L; p 0.20). There was no significant change in the serum galactomannan (favourable vs. unfavourable: mean ± SD, -0.11 ± 2.8 vs. -0.62 ± 2; p 0.92) or FEV1 (favourable vs. unfavourable: mean ± SD, 24 ± 250 mL vs. -62 ± 154 mL; p 0.19) after 6 months of treatment. There was significant loss of weight (mean ± SD, -2.5 ± 4.5 kg) in subjects with unfavourable response.
Serum A. fumigatus-specific IgG and serum galactomannan inconsistently decrease following treatment and may not be useful indicators for monitoring treatment response in CPA. Similarly, there is little change in pulmonary function following treatment. A gain in body weight is seen in those with favourable response.
慢性肺曲霉病（CPA）的治疗反应通常基于临床和影像学发现的改善来评估。在此，我们评估了血清烟曲霉特异性 IgG、血清半乳甘露聚糖、体重变化和肺功能，以评估 CPA 患者的治疗反应。
我们将治疗反应分为有利（临床症状改善或稳定，影像学显示疾病改善或稳定）或不利（症状恶化或影像学进展），治疗时间为抗真菌唑类药物治疗 6 个月后。我们在治疗反应有利和不利的患者中测量了基线、3 个月和 6 个月时的烟曲霉特异性 IgG、血清半乳甘露聚糖、体重和肺功能。
纳入了 126 例连续的初治 CPA 患者（53.2%（67/126）为男性；平均年龄±标准差，42.3±14.7 岁）。106 例和 20 例患者分别被归类为治疗反应有利和不利。治疗 6 个月后，血清烟曲霉特异性 IgG（n=119）下降在治疗反应有利和不利的患者中相似（平均±标准差，-26.3±45.5 mgA/L 与-3.4±65.6 mgA/L；p=0.20）。血清半乳甘露聚糖（有利与不利：平均±标准差，-0.11±2.8 与-0.62±2；p=0.92）或 FEV1（有利与不利：平均±标准差，24±250 mL 与-62±154 mL；p=0.19）在治疗 6 个月后均无显著变化。治疗反应不利的患者体重明显减轻（平均±标准差，-2.5±4.5 kg）。
血清烟曲霉特异性 IgG 和血清半乳甘露聚糖在治疗后不一致地降低，可能不是监测 CPA 治疗反应的有用指标。同样，治疗后肺功能变化不大。治疗反应有利的患者体重增加。
