Pak Chuiyong, Jo Woori, Kim Jin Hyoung, Im Jae Uk, Jeong Joseph, Cha Hee Jeong, Choi Eun-Young, Ra Seung Won
Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Tuberc Respir Dis (Seoul). 2021 Oct;84(4):326-332. doi: 10.4046/trd.2021.0029. Epub 2021 Jun 24.
The association of invasive tracheobronchial aspergillosis (ITBA) with invasive pulmonary aspergillosis (IPA) is not well established. We aimed to compare clinical characteristics between patients who exhibited ITBA with IPA and those who exhibited isolated ITBA (iITBA). Additionally, the usefulness of serum or bronchial galactomannan (GM) tests in diagnosing ITBA was evaluated.
This retrospective single-center case-control study was conducted over a period of 4 years. Fifteen patients were enrolled after confirming the presence of ITBA using bronchoscopy-guided biopsy (iITBA, 7 vs. ITBA+IPA, 8). Clinical characteristics of patients and results obtained from serum or bronchial GM tests were compared between the two groups. Mortality was assessed using data collected from a 6-month follow-up period.
The ITBA+IPA group showed a higher prevalence of hematologic malignancy (75% vs. 14%, p=0.029), a greater number of patients with multiple bronchial ulcers (75% vs. 14%, p=0.029), lower platelet counts (63,000/μL vs. 229,000/μL, p<0.001), and a mortality rate which was significantly higher (63% vs. 0%, p=0.026) than the iITBA group. In the ITBA+IPA group, 57% of patients tested positive according to the serum GM assay, whereas in the iITBA group, all patients tested negative (p=0.070). The bronchial GM level was high in both groups, but there was no significant difference between them.
Patients with ITBA+IPA had a greater number of hematologic malignancies with lower platelet counts and a poorer prognosis than patients diagnosed with iITBA. Findings obtained from bronchoscopy and bronchial GM tests were more useful in diagnosing ITBA than the serum GM test results.
侵袭性气管支气管曲霉病（ITBA）与侵袭性肺曲霉病（IPA）之间的关联尚未明确。我们旨在比较同时患有ITBA和IPA的患者与仅患有孤立性ITBA（iITBA）的患者的临床特征。此外，还评估了血清或支气管半乳甘露聚糖（GM）检测在诊断ITBA中的效用。
这项回顾性单中心病例对照研究历时4年。在通过支气管镜引导活检确诊为ITBA后，纳入了15例患者（iITBA组7例，ITBA + IPA组8例）。比较了两组患者的临床特征以及血清或支气管GM检测结果。使用6个月随访期收集的数据评估死亡率。
ITBA + IPA组血液系统恶性肿瘤的患病率更高（75% 对14%，p = 0.029），有多个支气管溃疡的患者更多（75% 对14%，p = 0.029），血小板计数更低（63,000/μL对229,000/μL，p < 0.001），死亡率也显著高于iITBA组（63% 对0%，p = 0.026）。在ITBA + IPA组中，57%的患者血清GM检测呈阳性，而在iITBA组中，所有患者检测均为阴性（p = 0.070）。两组的支气管GM水平均较高，但两者之间无显著差异。
与诊断为iITBA的患者相比，ITBA + IPA患者的血液系统恶性肿瘤更多，血小板计数更低，预后更差。支气管镜检查和支气管GM检测结果在诊断ITBA方面比血清GM检测结果更有用。
