囊性纤维化患者曲霉菌生长的多种临床特征。

Diverse clinical characteristics of Aspergillus growth in patients with cystic fibrosis.

机构信息

Departments of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Departments of Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

出版信息

Turk J Pediatr. 2020;62(4):560-568. doi: 10.24953/turkjped.2020.04.005.

DOI:10.24953/turkjped.2020.04.005

PMID:32779408

Abstract

BACKGROUND AND OBJECTIVES

Patients with cystic fibrosis (CF) have a varying spectrum of clinically significant Aspergillus disease in addition to allergic bronchopulmonary aspergillosis (ABPA). Here we aimed to review the different clinical phenotypes related with Aspergillus growth on the airway culture of patients with CF, we also aimed to investigate the effect of Aspergillus growth on lung function tests.

METHOD

The medical records of 100 patients with CF who had Aspergillus growth on airway culture within the period of April 2001 and June 2016 were retrospectively analyzed. Age, gender, symptoms, physical examination findings, pulmonary function tests, the diagnosis of ABPA, and airway culture results were recorded for every visit. Patients with Aspergillus growth on airway cultures were classified into different groups as ABPA, Aspergillus sensitization, Aspergillus colonization and Aspergillus bronchitis.

RESULTS

Medical records of 83 patients and 147 sputum cultures were attained from 100 patients. The mean age of the patients was 17.6±7.6 years and the mean age of the first Aspergillus growth in sputum culture was 12.5±6.7 years. At first isolation, Aspergillus fumigatus SC was the most common Aspergillus SC in sputum (76.3%) and 14.5% of these patients required hospitalization. Aspergillus sensitization was diagnosed in 3.6% (n= 3) of the patients. Aspergillus colonization was diagnosed in 18.1% (n= 15) of all patients and led to a decline in FEV1%, FVC% and FEF25-75% which was not statistically significant, furthermore. ABPA was detected in 9.6% (n= 8) of all patients and led to a statistically significant decline in FEV1% (p= 0.02); nonsignificant decline in FVC% and FEF25-75%. Aspergillus bronchitis was detected in 43.4% (n= 36) of all patients and led to nonsignificant decline in FEV1%, FVC% and FEF25-75%.

CONCLUSION

ABPA is recognized as the most common Aspergillus associated disorder in CF patients and is related to deteriorated pulmonary function tests; however Aspergillus colonization and bronchitis may also be associated with worsening lung function.

摘要

背景与目的

囊性纤维化（CF）患者除变应性支气管肺曲霉病（ABPA）外，还存在不同程度的具有临床意义的曲霉菌病。本研究旨在回顾 CF 患者气道培养中曲霉菌生长相关的不同临床表型，并探讨曲霉菌生长对肺功能检查的影响。

方法

回顾性分析 2001 年 4 月至 2016 年 6 月期间气道培养中曲霉菌生长的 100 例 CF 患者的病历资料。记录每位患者的年龄、性别、症状、体格检查结果、肺功能检查、ABPA 诊断和气道培养结果。根据气道培养结果，将曲霉菌生长的患者分为 ABPA、曲霉菌致敏、曲霉菌定植和曲霉菌性支气管炎。

结果

100 例患者的病历记录 83 例，痰培养 147 例。患者的平均年龄为 17.6±7.6 岁，首次痰培养中曲霉菌生长的平均年龄为 12.5±6.7 岁。首次分离时，烟曲霉 SC 是最常见的气道曲霉菌 SC（76.3%），其中 14.5%的患者需要住院治疗。3.6%（n=3）的患者诊断为曲霉菌致敏。18.1%（n=15）的患者诊断为曲霉菌定植，这并未导致 FEV1%、FVC%和 FEF25-75%显著下降，此外，9.6%（n=8）的患者诊断为 ABPA，这导致 FEV1%显著下降（p=0.02）；FVC%和 FEF25-75%无显著下降。43.4%（n=36）的患者诊断为曲霉菌性支气管炎，这导致 FEV1%、FVC%和 FEF25-75%无显著下降。