印度北部 COPD 患者中曲霉菌致敏和变应性支气管肺曲霉病的人群患病率。

Population prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in COPD subjects in North India.

机构信息

Department of Community Medicine and School of Public Health, Postgraduate institute of medical education and Research, Chandigarh, India.

Department of Pulmonary Medicine, Postgraduate institute of medical education and Research, Chandigarh, India.

出版信息

Mycoses. 2024 Aug;67(8):e13784. doi: 10.1111/myc.13784.

DOI:10.1111/myc.13784

PMID:39123291

Abstract

BACKGROUND

Sensitization to Aspergillus fumigatus (AS) has been recently described in chronic obstructive pulmonary disease (COPD) patients. However, there is no data on the community prevalence of AS in COPD.

OBJECTIVES

To assess the prevalence of AS among COPD subjects. The secondary objectives were to (1) assess the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in COPD and (2) compare the lung function in COPD subjects with and without AS.

METHODS

We conducted a cross-sectional study in rural (29 villages) and urban (20 wards) communities in North India. We identified individuals with respiratory symptoms (IRS) through a house-to-house survey using a modified IUATLD questionnaire. We then diagnosed COPD through specialist assessment and spirometry using the GOLD criteria. We assayed A.fumigatus-specific IgE in COPD subjects. In those with A. fumigatus-specific IgE ≥0.35 kUA/L (AS), ABPA was diagnosed with raised serum total IgE and raised A.fumigatus-specific IgG or blood eosinophil count.

RESULTS

We found 1315 (8.2%) IRS among 16,071 participants >40 years and diagnosed COPD in 355 (2.2%) subjects. 291 (82.0%) were men and 259 (73.0%) resided in rural areas. The prevalence of AS and ABPA was 17.7% (95% CI, 13.9-21.8) and 6.6% (95% CI, 4.4-8.8). We found a lower percentage predicted FEV1 in COPD subjects with AS than those without (p =.042).

CONCLUSIONS

We found an 18% community prevalence of AS in COPD subjects in a specific area in North India. Studies from different geographical areas are required to confirm our findings. The impact of AS and ABPA on COPD requires further research.

摘要

背景

近年来，在慢性阻塞性肺疾病（COPD）患者中发现了对烟曲霉（AS）的致敏现象。然而，关于 COPD 患者中 AS 的社区流行率尚无数据。

目的

评估 COPD 患者中 AS 的流行率。次要目标是：（1）评估 COPD 中变应性支气管肺曲霉病（ABPA）的流行率；（2）比较 AS 阳性和阴性 COPD 患者的肺功能。

方法

我们在印度北部的农村（29 个村庄）和城市（20 个行政区）社区进行了一项横断面研究。我们通过使用改良的 IUATLD 问卷进行逐户调查，确定有呼吸道症状（IRS）的个体。然后，我们通过专科评估和使用 GOLD 标准进行的肺活量测定来诊断 COPD。我们在 COPD 患者中检测了 A.fumigatus 特异性 IgE。在 A.fumigatus 特异性 IgE≥0.35 kUA/L（AS）的患者中，通过升高的血清总 IgE、升高的 A.fumigatus 特异性 IgG 或血嗜酸性粒细胞计数诊断 ABPA。

结果

我们在 16071 名>40 岁的参与者中发现了 1315 名 IRS（8.2%），并在 355 名（2.2%）患者中诊断了 COPD。291 名（82.0%）为男性，259 名（73.0%）居住在农村地区。AS 和 ABPA 的患病率分别为 17.7%（95%CI，13.9-21.8）和 6.6%（95%CI，4.4-8.8）。我们发现 AS 阳性的 COPD 患者的预计 FEV1 百分比低于阴性患者（p=0.042）。