真菌相关性哮喘的临床表现和结局:台湾多机构数据库研究
2022/12/21
摘要
背景：真菌相关性哮喘的临床表型和结果的差异尚不清楚。我们的目的是研究真菌致敏和/或真菌分离阳性的哮喘患者的临床表现。
方法：从台湾最大的电子病历资料库-长庚研究资料库中检索2010-2018年间的患者的临床特征、肺功能、微生物学资料、过敏试验报告、急诊科就诊和住院情况。对每例患者进行3年随访。
结果：共纳入30754例哮喘患者，在应用排除标准后，7976例符合分析条件。在这些患者中，694人进行了痰真菌检查。患者被分为四组:第1组，既没有真菌致敏作用，也没有痰中真菌分离物(n = 386)；第2组，仅真菌致敏阳性(n = 58)；第3组，痰中真菌分离物阳性(n=217)，同时存在阳性真菌致敏和痰中真菌分离物阳性(n = 33)。真菌致敏哮喘患者(2组和4组)的IgE水平明显高于无致敏哮喘患者(1组和3组)。4组患者住院率较高。在Global Initiative for Asthma (GINA) step 4-5治疗的患者中，第4组哮喘患者的呼吸衰竭发生率明显较高。
结论：真菌致敏率和痰中真菌分离物的流行程度在不同哮喘严重程度的患者中相同，但真菌的临床影响可能在病情更严重的患者中更为显著。
Clinical manifestations and outcomes of fungus-associated asthma: A multi-institution database study in Taiwan.
Lo YL, Lin HC, Lo CY, Huang HY, Lin TY,
Abstrast
Background: Differences in the clinical phenotypes and outcomes of fungus-associated asthma remain unclear. We aimed to investigate the presentation of asthmatics with fungal sensitization and/or positive fungal isolates.
Methods: Clinical characteristics, pulmonary function, microbiological data, allergy test reports, emergency department (ED) visits and hospitalizations were retrieved from the Chang Gung Research Database between 2010 and 2018; the largest electronic medical record-based database in Taiwan. Follow-up care was provided to each patient for 3 years.
Results: A total of 30,754 asthmatics were enrolled, and 7976 were eligible for analysis after applying the exclusion criteria. Of these patients, 694 had sputum examinations for fungi. The patients were divided into four groups: group 1, neither fungal sensitization nor fungal isolates in the sputum (n = 386); group 2, positive fungal sensitization (n = 58); group 3, positive fungal isolates (n = 217); and group 4, concomitant positive fungal sensitization and positive fungal isolates (n = 33). Asthmatic patients with fungal sensitization (groups 2 and 4) demonstrated significantly higher IgE levels compared with those without (groups 1 and 3). Group 4 patients had a higher frequency of hospitalization. Amongst patients under Global Initiative for Asthma (GINA) step 4-5 therapies, group 4 asthmatics possessed significantly higher incidence of respiratory failure.
Conclusions: The prevalence of fungal sensitization and fungal isolates from sputum were even across asthmatic severities, but the clinical impact of fungi may be more significant among patients with more severe disease.
背景：真菌相关性哮喘的临床表型和结果的差异尚不清楚。我们的目的是研究真菌致敏和/或真菌分离阳性的哮喘患者的临床表现。
方法：从台湾最大的电子病历资料库-长庚研究资料库中检索2010-2018年间的患者的临床特征、肺功能、微生物学资料、过敏试验报告、急诊科就诊和住院情况。对每例患者进行3年随访。
结果：共纳入30754例哮喘患者，在应用排除标准后，7976例符合分析条件。在这些患者中，694人进行了痰真菌检查。患者被分为四组:第1组，既没有真菌致敏作用，也没有痰中真菌分离物(n = 386)；第2组，仅真菌致敏阳性(n = 58)；第3组，痰中真菌分离物阳性(n=217)，同时存在阳性真菌致敏和痰中真菌分离物阳性(n = 33)。真菌致敏哮喘患者(2组和4组)的IgE水平明显高于无致敏哮喘患者(1组和3组)。4组患者住院率较高。在Global Initiative for Asthma (GINA) step 4-5治疗的患者中，第4组哮喘患者的呼吸衰竭发生率明显较高。
结论：真菌致敏率和痰中真菌分离物的流行程度在不同哮喘严重程度的患者中相同，但真菌的临床影响可能在病情更严重的患者中更为显著。
(中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校)
(Microbiol Res 2023 Jan;266. doi: 110.1016/j.micres.2022.127234.IF: 3.97)
(Microbiol Res 2023 Jan;266. doi: 110.1016/j.micres.2022.127234.IF: 3.97)
Clinical manifestations and outcomes of fungus-associated asthma: A multi-institution database study in Taiwan.
Lo YL, Lin HC, Lo CY, Huang HY, Lin TY,
Abstrast
Background: Differences in the clinical phenotypes and outcomes of fungus-associated asthma remain unclear. We aimed to investigate the presentation of asthmatics with fungal sensitization and/or positive fungal isolates.
Methods: Clinical characteristics, pulmonary function, microbiological data, allergy test reports, emergency department (ED) visits and hospitalizations were retrieved from the Chang Gung Research Database between 2010 and 2018; the largest electronic medical record-based database in Taiwan. Follow-up care was provided to each patient for 3 years.
Results: A total of 30,754 asthmatics were enrolled, and 7976 were eligible for analysis after applying the exclusion criteria. Of these patients, 694 had sputum examinations for fungi. The patients were divided into four groups: group 1, neither fungal sensitization nor fungal isolates in the sputum (n = 386); group 2, positive fungal sensitization (n = 58); group 3, positive fungal isolates (n = 217); and group 4, concomitant positive fungal sensitization and positive fungal isolates (n = 33). Asthmatic patients with fungal sensitization (groups 2 and 4) demonstrated significantly higher IgE levels compared with those without (groups 1 and 3). Group 4 patients had a higher frequency of hospitalization. Amongst patients under Global Initiative for Asthma (GINA) step 4-5 therapies, group 4 asthmatics possessed significantly higher incidence of respiratory failure.
Conclusions: The prevalence of fungal sensitization and fungal isolates from sputum were even across asthmatic severities, but the clinical impact of fungi may be more significant among patients with more severe disease.
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非控制性或口服皮质类固醇依赖性过敏性和非过敏性哮喘患者的度普利尤单抗疗效
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极端温度引发的哮喘:从流行病学证据到生物学合理性
