烟曲霉特异性IgE增高与哮喘患者肺功能下降相关
2010/12/07
目前尚不确定烟曲霉过敏及其在气道内定植对哮喘患者的影响。为了了解烟曲霉相关性哮喘临床特征与实验室检查之间的关系，患者研究了79例哮喘患者（89%属于GINA分级4～5级），按照是否对烟曲霉过敏分为三组：(1)IgE阳性组（皮肤急性反应>3mm和/或IgE>0.35kU/L）；（2）仅IgG阳性组（IgG>40mg/L）；（3）非过敏组。选取14名健康人作为对照。行痰培养查找有无烟曲霉定植，并与临床指标相比较。63% IgE增高患者（n=40）痰中可培养出烟曲霉，39% IgG增高患者（n=13）、31%非过敏患者（n=26）及7% 健康对照者（n=14）痰中可培养出烟曲霉。与非过敏哮喘患者相比，对烟曲菌过敏的哮喘患者肺功能更低（支气管舒张试验后的FEV1/pred分别为68%（+/-5）,88%（p<0.05），支气管扩张更多见（分别为68%，35%，p<0.05），痰中中性粒细胞比值更高（分别为80.9%（50.1～94.1），49.5%（21.2～71.4），p<0.01）。多元回归分析显示烟曲霉特异性IgE增高及痰中性粒细胞比例增加是肺功能的重要预测因素（p=0.016），烟曲霉培养阳性（p=0.046）及痰嗜酸性粒细胞比例增加（p=0.024）也与肺功能下降相关。痰中培养出烟曲霉与烟曲霉特异性IgE增高，中性粒细胞性气道炎症、肺功能下降相关。哮喘患者出现固定的气流阻塞与气道内烟曲霉定植的破坏作用有关。
（马艳良 北京大学人民医院呼吸科 100044 摘译）
(Am J Respir Crit Care Med. 2010 Jul 16.)
Am J Respir Crit Care Med. 2010 Jul 16. [Epub ahead of print]
IgE Sensitisation to Aspergillus fumigatus is Associated with Reduced Lung
Function in Asthma.
Fairs A, Agbetile J, Hargadon B, Bourne M, Monteiro WR, Brightling CE, BraddingP, Green RH, Mutalithas K, Desai D, Pavord ID, Wardlaw AJ, Pashley CH.
RATIONALE:The importance of Aspergillus fumigatus sensitisation and colonisationof the airways in patients with asthma is unclear.
OBJECTIVES: To define therelationship between the clinical and laboratory features of A.fumigatus-associated asthma.
METHODS: We studied 79 patients with asthma (89%classed as GINA 4 or 5) classified into 3 groups according to A. fumigatussensitisation: (1) IgE-sensitised (immediate cutaneous reactivity >3 mm and/orIgE >0.35 kU/L); (2) IgG-only-sensitised (IgG >40 mg/L); and (3) non-sensitised. These were compared to 14 healthy controls. Sputum culture was focused towardsdetection of A. fumigatus and compared with clinical assessment data.
MEASUREMENTS AND MAIN RESULTS: A. fumigatus was cultured from 63% ofIgE-sensitised asthmatics (n=40), 39% of IgG-only-sensitised asthmatics (n=13),31% of non-sensitised asthmatics (n=26) and 7% of healthy controls (n=14).Patients sensitised to A. fumigatus compared with non-sensitised asthmatics hadlower lung function (% predicted, post-bronchodilator FEV1 68% (+/-5) vs 88% (5) p < 0.05), more bronchiectasis (68% versus 35% p < 0.05) and more sputumneutrophils (80.9% (50.1-94.1) vs 49.5% (21.2-71.4) p < 0.01). In a multilinearregression model A. fumigatus-IgE sensitisation and sputum neutrophildifferential cell count were important predictors of lung function (p=0.016),supported by culture of A. fumigatus (p=0.046) and eosinophil differential cellcount (p=0.024).
CONCLUSIONS: A. fumigatus detection in sputum is associated withA. fumigatus-IgE sensitisation, neutrophilic airway inflammation and reduced lungfunction. This supports the concept that development of fixed airflow obstructionin asthma is consequent upon the damaging effects of airway colonisation with A. fumigatus.
OBJECTIVES: To define therelationship between the clinical and laboratory features of A.fumigatus-associated asthma.
METHODS: We studied 79 patients with asthma (89%classed as GINA 4 or 5) classified into 3 groups according to A. fumigatussensitisation: (1) IgE-sensitised (immediate cutaneous reactivity >3 mm and/orIgE >0.35 kU/L); (2) IgG-only-sensitised (IgG >40 mg/L); and (3) non-sensitised. These were compared to 14 healthy controls. Sputum culture was focused towardsdetection of A. fumigatus and compared with clinical assessment data.
MEASUREMENTS AND MAIN RESULTS: A. fumigatus was cultured from 63% ofIgE-sensitised asthmatics (n=40), 39% of IgG-only-sensitised asthmatics (n=13),31% of non-sensitised asthmatics (n=26) and 7% of healthy controls (n=14).Patients sensitised to A. fumigatus compared with non-sensitised asthmatics hadlower lung function (% predicted, post-bronchodilator FEV1 68% (+/-5) vs 88% (5) p < 0.05), more bronchiectasis (68% versus 35% p < 0.05) and more sputumneutrophils (80.9% (50.1-94.1) vs 49.5% (21.2-71.4) p < 0.01). In a multilinearregression model A. fumigatus-IgE sensitisation and sputum neutrophildifferential cell count were important predictors of lung function (p=0.016),supported by culture of A. fumigatus (p=0.046) and eosinophil differential cellcount (p=0.024).
CONCLUSIONS: A. fumigatus detection in sputum is associated withA. fumigatus-IgE sensitisation, neutrophilic airway inflammation and reduced lungfunction. This supports the concept that development of fixed airflow obstructionin asthma is consequent upon the damaging effects of airway colonisation with A. fumigatus.
PMID: 20639442 [PubMed - as supplied by publisher]
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