哮喘联盟

   摘要
   总的来说，哮喘、慢性阻塞性肺疾病(COPD)和囊性纤维化(CF)是导致健康损害的非常常见的疾病和重要原因。上述三组疾病均可出现气道丝状真菌定植，尽管临床相关性尚不明确。目前已经公认变应性支气管肺曲菌病(ABPA)是一个主要与烟曲霉菌气道定植相关的严重并发症。未满足所有ABPA诊断标准的真菌定植可能产生会有不良影响；但呼吸道样本处理标准的缺乏阻碍了相互间但比较。虽然真菌学实验室认证的项目很普遍，但大多数国家没有对于呼吸道样本处理的国家标准指南。在CF、哮喘和COPD患者痰中真菌回收率分别约为40%、54%和49%。分离自痰液中的真菌与哮喘和CF患者肺功能减少相关，但是在COPD中无该关联性。并不清楚真菌定植是否会导致更低的肺功能，或是否可作为更严重肺部疾病和实施侵袭性治疗的一个指标。真菌致敏可能导致持续的呼吸道症状；但并不清楚确切的患病率。已知烟曲霉的致敏性与哮喘、COPD和CF的肺功能降低相关。以上提示，由于试验结果的不一致性，因此在诊断过敏性疾病时应使用ImmunoCAP系统同时进行皮肤点刺试验和特异性lgE测定；但关于针对哪种真菌应进行这类检测，目前仍无有被广泛采纳的共识。
 

（林江涛 审校）
 Mycopathologia.2014 Aug 24. [Epub ahead of print]
 

Fungal Culture and Sensitisation in Asthma, Cystic Fibrosis and Chronic Obstructive Pulmonary Disorder: What Does It Tell Us?
 

Pashley CH.
 

Abstract
Collectively asthma, chronic obstructive pulmonary disorder (COPD) and cystic fibrosis (CF) are very common, important causes of disease and ill health. Filamentous fungal colonisation of the airways can occur in all three disease groups, although the clinical relevance is unclear. Allergic bronchopulmonaryaspergillosis (ABPA) is a well-recognised severe complication of airway colonisation associated primarily with Aspergillusfumigatus. Fungal colonisation may have a deleterious effect without fulfilling all the diagnostic criteria of ABPA; however, a lack of standardisation in processing respiratory samples hampers comparisons. Whilst mycology laboratory accreditation programs are common, most countries have no national standard guidelines for processing respiratory samples. Fungal recovery from sputum in CF, asthma and COPD can be around 40, 54 and 49 %, respectively. Isolation of fungi from sputum has been associated with reduced lung function in asthma and CF, although no such associations have been found in COPD. It is unclear whether fungal colonisation contributes to lower lung function or is a marker of more severe lung disease and aggressive therapy. Fungal sensitisation may contribute to the persistence of active respiratory symptoms; however, the exact prevalence is unclear. Sensitisation to A. fumigatus has been associated with reduced lung function in asthma, COPD and CF. It has suggested that both skin prick tests and specific IgE measurement by the ImmunoCAP system should be used in diagnoses of allergy, due to discordance in test results; however, there is currently no widely adopted consensus as to which fungi to test for.
 

Mycopathologia.2014 Aug 24. [Epub ahead of print]