过敏性支气管肺曲霉病/真菌病中血清癌胚抗原升高的临床意义：一项多中心回顾性研究
Clinical Relevance of Elevated Serum Carcinoembryonic Antigen in Allergic Bronchopulmonary Aspergillosis/Mycosis: A Multicenter Retrospective Study.
作者信息
Ge Huan, Cai Runjin, Chen Xuemei, Liu Bin, Hu Xinyue, Deng Shuanglinzi, Li Hui, Dai Lixue, Tang Jiale, Tang Huan, Gong Xiaoxiao, Wu Chendong, Wang Guo, Li Guotao, Liu Bing, Wang Jun, Tang Yuling, Li Xiaozhao, Feng Juntao
机构信息
Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, People's Republic of China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People's Republic of China.
出版信息
J Asthma Allergy. 2024 Dec 25;17:1313-1323. doi: 10.2147/JAA.S494250. eCollection 2024.
BACKGROUND
Allergic bronchopulmonary aspergillosis/mycosis (ABPA/M) is a complex non-infectious pulmonary benign disease characterized by an immune response against aspergillus/fungus. Carcinoembryonic antigen (CEA), typically recognized as a tumor marker, also elevated in certain benign diseases. Few studies on ABPA/M cases presenting with elevated serum CEA levels have been reported.
PATIENTS AND METHODS
A cohort of 115 patients diagnosed as ABPA/M were divided into two groups (CEA normal and CEA elevated). The characteristics of ABPA/M patients in terms of its demographic profile, clinical symptoms, pertinent clinical laboratory examinations were analyzed. Levels of cytokines (IL-4, IL-5, GM-CSF, IFN-γ) were analyzed by enzyme-linked immunosorbent assay. Comparative evaluation included pre-therapy and post-treatment eosinophil count and total IgE level, to evaluate therapeutic disparities between the two groups.
RESULTS
Among 115 cases of ABPA/M, 32 exhibited elevated serum CEA levels above baseline and 83 were normal. ABPA/M patients with elevated serum CEA tended to be younger (50, IQR [43-56] years vs 59, IQR [47-68] years; P < 0.05) with superior pulmonary function (FEV1/FVC ratio, 65.1% (44.2, 79.6) vs 79.1% (65.2, 84.2), P < 0.05), and showed marginally higher baseline levels of the total IgE (P < 0.05), blood eosinophils counts and ratios (P < 0.01) compared to those with normal CEA. Higher serum levels of IL-4, IL-5, GM-CSF and IFN-γ in ABPA/M patients with elevated serum CEA levels were observed (P < 0.0001). After treatment (at 12w), compared to ABPA/M patients with normal serum CEA, the decrease in eosinophil count and total IgE levels was less pronounced in ABPA/M patients with elevated serum CEA eosinophil count, 523±481.66 vs 267±200.68, P < 0.05; total IgE, 619±680.47 vs 263±400.90, P < 0.05), which indicates a poor response to treatment.
CONCLUSION
Monitoring serum CEA levels may serve as a supplementary tool in the clinical management of ABPA/M patients.
背景
变应性支气管肺曲霉病/真菌病（ABPA/M）是一种复杂的非感染性肺部良性疾病，其特征为针对曲霉/真菌的免疫反应。癌胚抗原（CEA）通常被认为是一种肿瘤标志物，但在某些良性疾病中也会升高。关于血清CEA水平升高的ABPA/M病例的研究报道较少。
患者与方法
将115例诊断为ABPA/M的患者分为两组（CEA正常组和CEA升高组）。分析ABPA/M患者在人口统计学特征、临床症状、相关临床实验室检查方面的特点。采用酶联免疫吸附测定法分析细胞因子（IL-4、IL-5、GM-CSF、IFN-γ）水平。比较评估包括治疗前和治疗后嗜酸性粒细胞计数及总IgE水平，以评估两组之间的治疗差异。
结果
在115例ABPA/M病例中，32例血清CEA水平高于基线，83例正常。血清CEA升高的ABPA/M患者往往更年轻（50岁[四分位间距43 - 56岁] vs 59岁[四分位间距47 - 68岁]；P < 0.05），肺功能较好（FEV1/FVC比值，65.1%[44.2, 79.6] vs 79.1%[65.2, 84.2]，P < 0.05），且与CEA正常的患者相比，总IgE（P < 0.05）、血嗜酸性粒细胞计数及比例（P < 0.01）的基线水平略高。观察到血清CEA水平升高的ABPA/M患者中IL-4、IL-5、GM-CSF和IFN-γ的血清水平较高（P < 0.0001）。治疗后（12周时），与血清CEA正常的ABPA/M患者相比，血清CEA升高的ABPA/M患者嗜酸性粒细胞计数和总IgE水平的下降不太明显（嗜酸性粒细胞计数，523±481.66 vs 267±200.68，P < 0.05；总IgE，619±680.47 vs 263±400.90，P < 0.05），这表明治疗反应较差。
结论
监测血清CEA水平可作为ABPA/M患者临床管理中的一种辅助工具。
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