Pollock Jennifer, Goeminne Pieter C, Aliberti Stefano, Polverino Eva, Crichton Megan L, Ringshausen Felix C, Dhar Raja, Vendrell Montserrat, Burgel Pierre-Régis, Haworth Charles S, De Soyza Anthony, De Gracia Javier, Bossios Apostolos, Rademacher Jessica, Grünewaldt Achim, McDonnell Melissa, Stolz Daiana, Sibila Oriol, van der Eerden Menno, Kauppi Paula, Hill Adam T, Wilson Robert, Amorim Adelina, Munteanu Oxana, Menendez Rosario, Torres Antoni, Welte Tobias, Blasi Francesco, Boersma Wim, Elborn J Stuart, Shteinberg Michal, Dimakou Katerina, Chalmers James D, Loebinger Michael R
Division of Respiratory Medicine and Gastroenterology, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland.
Department of Respiratory Disease, VITAZ Hospital, Sint-Nikolaas, Belgium.
Chest. 2025 Apr;167(4):975-992. doi: 10.1016/j.chest.2024.06.3843. Epub 2024 Oct 24.
Aspergillus species cause diverse clinical manifestations in bronchiectasis including allergic bronchopulmonary aspergillosis (ABPA), Aspergillus sensitization (AS), and raised IgG indicating exposure to, or infection with, Aspergillus.
What are the prevalence and clinical significance of Aspergillus-associated conditions in individuals with bronchiectasis?
Patients with bronchiectasis enrolled into the European Bronchiectasis Registry from 2015 through 2022 with laboratory testing for Aspergillus lung disease (total IgE, IgE specific to Aspergillus or Aspergillus skin test, or IgG specific to Aspergillus and blood eosinophil counts) were included for analysis. Modified International Society for Human and Anima Mycology ABPA working group criteria (2024) were used to define ABPA.
Nine thousand nine hundred fifty-three patients were included. Six hundred eight patients (6.1%) were classified as having ABPA, 570 patients (5.7%) showed AS, 806 patients (8.1%) showed raised Aspergillus-specific IgG without AS, 184 patients (1.8%) showed both AS and had raised Aspergillus-specific IgG levels, and 619 patients (6.2%) demonstrated eosinophilic bronchiectasis (elevated eosinophil counts without evidence of Aspergillus lung disease). The remaining 72% showed negative Aspergillus serologic findings. Patients with ABPA, AS, or raised Aspergillus-specific IgG demonstrated more severe disease, with worse lung function and more frequent exacerbations at baseline. During long-term follow-up, patients with raised Aspergillus-specific IgG experienced higher exacerbation frequency and more severe exacerbations. AS was associated with increased exacerbations and hospitalizations only in patients not receiving inhaled corticosteroids.
Aspergillus lung disease is common in bronchiectasis. Raised IgG levels to Aspergillus were associated with significantly worse outcomes, whereas ABPA and AS were associated with severe disease and exacerbations with a risk that is attenuated by inhaled corticosteroid use.
曲霉菌种在支气管扩张症中可引起多种临床表现，包括变应性支气管肺曲霉菌病（ABPA）、曲霉菌致敏（AS）以及提示暴露于曲霉菌或曲霉菌感染的IgG升高。
支气管扩张症患者中曲霉菌相关疾病的患病率及临床意义是什么？
纳入2015年至2022年登记入欧洲支气管扩张症注册研究的支气管扩张症患者，这些患者进行了曲霉菌肺病的实验室检测（总IgE、曲霉菌特异性IgE或曲霉菌皮肤试验、曲霉菌特异性IgG以及血液嗜酸性粒细胞计数）并进行分析。采用改良的国际人类和动物真菌学协会ABPA工作组标准（2024年）来定义ABPA。
共纳入9953例患者。608例患者（6.1%）被分类为患有ABPA，570例患者（5.7%）表现为AS，806例患者（8.1%）表现为曲霉菌特异性IgG升高但无AS，184例患者（1.8%）既表现为AS又有曲霉菌特异性IgG水平升高，619例患者（6.2%）表现为嗜酸性粒细胞性支气管扩张（嗜酸性粒细胞计数升高但无曲霉菌肺病证据）。其余72%的患者曲霉菌血清学检查结果为阴性。患有ABPA、AS或曲霉菌特异性IgG升高的患者疾病更严重，基线时肺功能更差且病情加重更频繁。在长期随访中，曲霉菌特异性IgG升高的患者病情加重频率更高且加重程度更严重。仅在未接受吸入性糖皮质激素治疗的患者中，AS与病情加重和住院增加有关。
曲霉菌肺病在支气管扩张症中很常见。曲霉菌特异性IgG水平升高与明显更差的预后相关，而ABPA和AS与严重疾病及病情加重相关，吸入性糖皮质激素的使用可降低这种风险。
