支气管扩张严重程度对变应性支气管肺曲霉病患者临床结局的影响：一项回顾性队列研究

Impact of Bronchiectasis Severity on Clinical Outcomes in Patients With Allergic Bronchopulmonary Aspergillosis: A Retrospective Cohort Study.

作者信息

Sehgal Inderpaul S, Muthu Valliappan, Dhooria Sahajal, Prasad Kuruswamy T, Garg Mandeep, Rudramurthy Shivaprakash M, Aggarwal Ashutosh N, Chakrabarti Arunaloke, Agarwal Ritesh

机构信息

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

出版信息

J Allergy Clin Immunol Pract. 2025 May;13(5):1103-1109.e2. doi: 10.1016/j.jaip.2025.03.005. Epub 2025 Mar 13.

DOI:10.1016/j.jaip.2025.03.005

PMID:40088971

Abstract

BACKGROUND

The impact of bronchiectasis severity on the outcomes of patients with allergic bronchopulmonary aspergillosis (ABPA) remains uncertain.

OBJECTIVE

To evaluate whether bronchiectasis severity is associated with an increased risk of ABPA exacerbations.

METHODS

We retrospectively analyzed patients with ABPA between 2007 and 2019. Patients were categorized based on the segments involved by bronchiectasis as mild (1-5), moderate (6-9), and extensive (≥10). We compared lung function and immunological markers among the groups. A multivariable Poisson regression analysis, using follow-up duration as an offset variable, assessed the association between bronchiectasis severity and ABPA exacerbations, adjusting for key confounders. We report the association as an adjusted relative rate (aRR) with 95% confidence intervals (CI).

RESULTS

We included 705 patients with ABPA (mean age, 35 years). Of these, 219 (31.1%), 226 (32.1%), and 260 (36.9%) had mild, moderate, and extensive bronchiectasis, respectively. Patients with extensive bronchiectasis had poorer lung function and elevated immunological markers (serum total IgE, Aspergillus fumigatus-IgE, and A. fumigatus-IgG) than those with mild or moderate bronchiectasis. The exacerbation frequency increased with the severity of bronchiectasis (mild: 41.5% vs moderate: 53.4% vs extensive: 57.7%, P = .005). On multivariable analysis, the risk of ABPA exacerbation increased significantly with bronchiectasis severity (aRR [95% CI]; extensive: 1.51 [1.09-2.08], moderate: 1.50 [1.09-2.08]). In addition, increasing age (aRR, 0.84 [95% CI, 0.76-0.94]) and body mass index (aRR, 0.97 [95% CI, 0.94-0.99]) were associated with lower exacerbation risk after adjusting for total IgE, lung function, and high-attenuation mucus.

CONCLUSION

Moderate-to-extensive bronchiectasis is associated with worse lung function, heightened immunological severity, and an increased risk of ABPA exacerbation.

摘要

背景

支气管扩张严重程度对变应性支气管肺曲霉病（ABPA）患者预后的影响仍不确定。

目的

评估支气管扩张严重程度是否与ABPA急性加重风险增加相关。

方法

我们回顾性分析了2007年至2019年间的ABPA患者。根据支气管扩张累及的节段将患者分为轻度（1 - 5个节段）、中度（6 - 9个节段）和重度（≥10个节段）。我们比较了各组之间的肺功能和免疫指标。采用多变量泊松回归分析，以随访时间作为偏移变量，评估支气管扩张严重程度与ABPA急性加重之间的关联，并对关键混杂因素进行校正。我们将该关联报告为调整后的相对率（aRR）及95%置信区间（CI）。

结果

我们纳入了705例ABPA患者（平均年龄35岁）。其中，分别有219例（31.1%）、226例（32.1%）和260例（36.9%）患有轻度、中度和重度支气管扩张。重度支气管扩张患者的肺功能较轻度或中度支气管扩张患者更差，免疫指标（血清总IgE、烟曲霉IgE和烟曲霉IgG）升高。急性加重频率随支气管扩张严重程度增加而升高（轻度：41.5% vs中度：53.4% vs重度：57.7%，P = 0.005）。多变量分析显示，ABPA急性加重风险随支气管扩张严重程度显著增加（aRR [95% CI]；重度：1.51 [1.09 - 2.08]，中度：1.50 [1.09 - 2.08]）。此外，校正总IgE、肺功能和高密度黏液后，年龄增加（aRR，0.84 [95% CI，0.76 - 0.94]）和体重指数增加（aRR，0.97 [95% CI，0.94 - 0.99]）与急性加重风险降低相关。