Aspergillus serology and clinical outcomes in patients with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC).

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2024-10-24 DOI:10.1016/j.chest.2024.06.3843

J Pollock, P C Goeminne, S Aliberti, E Polverino, M L Crichton, F C Ringshausen, R Dhar, M Vendrell, P R Burgel, C S Haworth, A De Soyza, J De Gracia, A Bossios, J Rademacher, A Grünewaldt, M McDonnell, D Stolz, O Sibila, M van der Eerden, P Kauppi, A T Hill, R Wilson, A Amorim, O Munteanu, R Menendez, A Torres, T Welte, F Blasi, W Boersma, J S Elborn, M Shteinberg, K Dimakou, J D Chalmers, M R Loebinger

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Abstract

Introduction: Aspergillus sp. cause diverse clinical manifestations in bronchiectasis including Allergic bronchopulmonary aspergillosis (ABPA), Aspergillus sensitization (AS) and raised IgG indicating exposure or infection with Aspergillus.

Research question: What is the prevalence and clinical significance of Aspergillus-associated conditions in individuals with bronchiectasis?

Methods: Bronchiectasis patients enrolled into the EMBARC registry from 2015 to 2022 with laboratory testing for Aspergillus lung disease (total IgE, specific IgE to Aspergillus or Aspergillus skin test, IgG to Aspergillus and blood eosinophil counts) were included for analysis. Modified-ISHAM-ABPA working group criteria (2021) were used to define ABPA.

Results: 9953 patients were included. 608 (6.1%) were classified as having ABPA, 570 (5.7%) showed Aspergillus sensitization, 806 (8.1%) had raised Aspergillus-specific IgG without sensitisation, 184 (1.8%) were both sensitised to Aspergillus and had raised Aspergillus-specific IgG and 619 (6.2%) had eosinophilic bronchiectasis (elevated eosinophil counts without evidence of Aspergillus lung disease). The remaining 72.0% had negative Aspergillus serology. Patients with ABPA, Aspergillus sensitization, and raised Aspergillus-specific IgG had more severe disease, with worse lung function and more frequent exacerbations at baseline. During long-term follow-up, patients with raised Aspergillus-specific IgG had higher exacerbation frequency and more severe exacerbations. Aspergillus sensitization associated with increased exacerbations and hospitalisations only in patients not receiving inhaled corticosteroids.

Interpretation: Aspergillus lung disease is common in bronchiectasis. Raised IgG to Aspergillus is associated with significantly worse outcomes while ABPA and Aspergillus sensitization are associated with severe disease and exacerbations with a risk that is attenuated by inhaled corticosteroid use.

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支气管扩张症患者的曲霉菌血清学和临床疗效：欧洲支气管扩张症登记处（EMBARC）的数据。

导言：曲霉菌会导致支气管扩张症患者出现多种临床表现，包括过敏性支气管肺曲霉菌病（ABPA）、曲霉菌致敏（AS）以及表明曲霉菌暴露或感染的IgG升高：研究问题：支气管扩张症患者中曲霉菌相关疾病的发病率和临床意义如何？纳入2015年至2022年EMBARC注册的支气管扩张症患者，对其进行曲霉菌肺病实验室检测（总IgE、曲霉菌特异性IgE或曲霉菌皮试、曲霉菌IgG和血液嗜酸性粒细胞计数）进行分析。采用改良-ISHAM-ABPA 工作组标准（2021 年）来定义 ABPA：结果：共纳入 9953 例患者。结果：共纳入 9953 例患者，其中 608 例（6.1%）被归类为 ABPA，570 例（5.7%）表现为曲霉菌致敏，806 例（8.1%）曲霉菌特异性 IgG 升高但未致敏，184 例（1.8%）既对曲霉菌致敏又有曲霉菌特异性 IgG 升高，619 例（6.2%）为嗜酸粒细胞性支气管扩张（嗜酸粒细胞计数升高但无曲霉菌肺病证据）。其余 72.0% 的患者曲霉菌血清学检测呈阴性。ABPA、曲霉菌致敏和曲霉菌特异性 IgG 升高的患者病情更严重，肺功能更差，基线病情加重更频繁。在长期随访中，曲霉菌特异性 IgG 升高的患者病情加重的频率更高，病情加重的程度也更严重。只有在未接受吸入皮质类固醇治疗的患者中，曲霉菌致敏才会导致病情加重和住院次数增加：曲霉菌肺病在支气管扩张症中很常见。曲霉菌 IgG 升高与明显恶化的预后有关，而 ABPA 和曲霉菌致敏与严重疾病和病情恶化有关，吸入皮质类固醇可降低这种风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.