Ehret N, Carlier N, Marey J, Rabbat A, Burgel P-R, Roche N
Service de pneumologie, université Paris Descartes, groupe hospitalier Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Service de pneumologie, université Paris Descartes, groupe hospitalier Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Rev Mal Respir. 2020 Apr;37(4):308-319. doi: 10.1016/j.rmr.2020.02.011. Epub 2020 Apr 10.
The relations between chronic obstructive pulmonary disease (COPD) and respiratory diseases due to Aspergillus spp. are not well understood.
We analysed a retrospective series of patients hospitalized with a diagnosis of COPD and respiratory disease due to Aspergillus. Patients were identified between 2010 and 2015 from the medico-administrative database of Cochin hospital, Paris. Historical, clinical, biological, microbiological and imaging data were collected and described. Diagnoses were reclassified based on reference definitions and classifications from the literature. Patients were classified according to the type of Aspergillus-related diseases and risk factors were described.
Forty patients were identified. Classifiable Aspergillus-related respiratory conditions were confirmed in 26 of them including 12 allergic bronchopulmonary aspergillosis (ABPA), 8 chronic pulmonary aspergillosis (CPA), 1 invasive pulmonary aspergillosis (IPA) and 3 diagnostic associations ABPA/CPA. Other respiratory comorbidities were present in all cases of CPA and immunodepression was recorded for semi-invasive and invasive forms. Finally, 16 patients could not be classified, among whom Aspergillus related lung disease was considered as likely in one-half.
The complexity of the diagnosis of pulmonary aspergillosis is related to its multiple types with sometimes unclear distinctions. Any type of pulmonary aspergillosis can be observed in patients with COPD, depending on associated risks factors. It would be helpful to establish specific classifications adapted to patients with COPD. This will require larger, prospective, multicentre studies.
慢性阻塞性肺疾病（COPD）与曲霉菌属引起的呼吸道疾病之间的关系尚未完全明确。
我们分析了一系列因慢性阻塞性肺疾病和曲霉菌引起的呼吸道疾病而住院的患者的回顾性资料。这些患者于2010年至2015年期间从巴黎科钦医院的医疗管理数据库中被识别出来。收集并描述了患者的病史、临床、生物学、微生物学和影像学数据。根据文献中的参考定义和分类对诊断进行重新分类。根据曲霉菌相关疾病的类型对患者进行分类，并描述相关危险因素。
共识别出40例患者。其中26例确诊为可分类的曲霉菌相关呼吸道疾病，包括12例变应性支气管肺曲霉菌病（ABPA）、8例慢性肺曲霉菌病（CPA）、1例侵袭性肺曲霉菌病（IPA）以及3例ABPA/CPA诊断关联病例。所有CPA病例均存在其他呼吸道合并症，半侵袭性和侵袭性病例均记录有免疫抑制情况。最后，16例患者无法分类，其中一半患者可能患有曲霉菌相关的肺部疾病。
肺曲霉菌病诊断的复杂性与其多种类型有关，有时区分并不明确。COPD患者中可观察到任何类型的肺曲霉菌病，这取决于相关危险因素。建立适用于COPD患者的特定分类将有所帮助。这需要更大规模的前瞻性多中心研究。
