Zhongguo quanke yixue (Oct 2023)
Prevalence and Clinical Characteristics of Allergic Bronchopulmonary Aspergillosis in Patients with Bronchiectasis
Abstract
Background Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease caused by aspergillus sensitization, which is often misdiagnosed or missed diagnosis due to low prevalence, few case reports, and controversial diagnostic criteria, leading to inappropriate treatment and exacerbation of the disease. Previous studies have shown that ABPA is one of the etiologies of bronchiectasis, but its prevalence and clinical characteristics still remain to be studied. Objective To analyze the prevalence and clinical characteristics of ABPA in patients with bronchiectasis. Methods Outpatients or inpatients diagnosed with bronchiectasis and received examinations for peripheral blood eosinophilcount, serum total IgE and aspergillus-specific IgE at Peking University Third Hospital from January 2012 to September 2021 were retrospectively selected. The data including gender, age, smoking history, asthma/wheezing symptoma, laboratory indicators (peripheral blood eosinophil count, serum total IgE, aspergillus-specific IgE and IgG), chest CT (types of bronchiectasis, number oflobes involved), and pulmonary function indexes〔the first forced expiratory volume as a percentage of the predicted value (FEV1%pred), ratio of the first forced expiratory volume and forced vital capacity in percentage (FEV1/FVC) 〕was collected. The Smith score and the Bhalla score was used to evaluate the extent and the severity of bronchiectasis lesions, respectively. The included patients were divided into the ABPA group (n=10) and non-ABPA group (n=149) according to the combination of ABPA and analyzed for the cases with total serum IgE>60 U/mL, total serum IgE>500 U/mL, total serum IgE>1 000 U/mL, aspergillus-specific IgE>0.35 U/mL, and peripheral blood eosinophil count >0.5×109/L. Results In 159 patients with bronchiectasis, 10 cases met the diagnostic criteria of ABPA (6.29%, 10/159) with elevated aspergillus-specific IgE level (>0.35 U/mL), including 9 cases with aspergillus-specific IgE>1 000 U/mL and 1 case with aspergillus-specific IgE<1 000 U/mL but fulfilled 3 other conditions (peripheral blood eosinophil count>0.5×109/L, radiological bronchiectasis, positive serum aspergillus-specific IgG), of whom 7 cases had episodic wheezingsymptom and 9 cases with absolute peripheral blood eosinophil count>0.5×109/L. Aspergillus-specific IgG was detected in 5 of the 10 cases with ABPA, 4 of whom were positive. Chest CT findings showed central bronchiectasis and peripheral bronchiectasis in 6 and 4 of the 10 cases with ABPA, and cystic bronchiectasis were shown in all 10 cases. Compared with the non-ABPA group, the ABPA group showed a higher number of lung lobesinvolved, Smith score and Bhalla score (P<0.05) . Conclusion Some casesmet the diagnostic criteria of ABPA among the patients diagnosed with bronchiectasis in the center, suggesting that total IgE and aspergillus-specific IgE should be detected in patients with central or severe bronchiectasis and increased peripheral blood eosinophils for the early diagnosis of ABPA.
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