Application Value Of Fractional Exhaled Nitric Oxide And Serological Indexes In The Diagnosis And Treatment Of Allergic Bronchopulmonary Aspergillosis

BackgroundAllergic bronchopulmonary aspergillosis(ABPA)is a pulmonary allergic disease caused by the body’s allergy to the Aspergillus antigen colonized in the bronchus,which mainly occurs in patients with asthma or pulmonary cystic fibrosis.According to statistics,there are 5 million people suffer from ABPA approximately in the world,of which up to 490,000 people have been diagnosed in China.Studies shows that the proportion of ABPA is increasing among asthma patients.However,the early clinical manifestations of ABPA often lack of specificity,and It is difficult to distinguish it from patients with allergic asthma by clinical manifestations.In advanced ABPA,irreversible bronchiectasis occurs and lung function deteriorates continuously will lead to pulmonary fibrosis ultimately.Therefore,the early identification and diagnosis of ABPA is still a major clinical problem,and it is particularly important to find suitable biomarkers actively for the early diagnosis of ABPA.Fractional exhaled nitric oxide(FeNO)is a non-invasive and easy-to-monitor airway inflammation marker,whose concentration is closely related to the severity of inflammation,and has been widely used in the diagnosis and treatment of allergic diseases.This study investigates the clinical application value of combined detection of FeNO and serum indexes in the diagnosis and treatment of ABPA by measuring the levels of FeNO and various serum indexes in ABPA patients.ObjectiveBy analyzing the levels of FeNO and serological indicators in ABPA patients,the diagnostic value and curative effect evaluation of FeNO and serological indicators(tIgE,sIgE,etc)in ABPA is explored initially.Materials and MethodsA retrospective analysis of 67 patients diagnosed with ABPA for the first time who went to the First Affiliated Hospital of Zhengzhou University from October 2018 to December 2020 and received oral hormone therapy for more than 4 weeks as the observation group.In addition,50 non-ABPA asthma patients in the acute stage who were hospitalized during the same period were selected as the control group.According to the presence or absence of central bronchiectasis and bronchial mucus plug in chest HRCT at admission,they were divided into serological ABPA(ABPA-S)group 29 cases and ABPA with central bronchiectasis(ABPA-B)group 38 cases.At the same time,the ABPA patients are divided into effective and ineffective groups according to the effect of hormone treatment.This study mainly analyzes whether there are statistical differences in FeNO and serum indexes between the ABPA group and the control group and between the subgroups of the ABPA group(ABPA-S group and ABPA-B group,pre-hormonal treatment group and post-hormonal treatment group,effective group and ineffective group).It explores the clinical application value of combined detection of FeNO and serological indicators in the diagnosis and treatment of ABPA preliminarily.Results1.67 ABPA patients were diagnosed to meet the inclusion criteria,with an average age of 46±17 years,26 males and 41 females.Among them,29 cases were ABPA-S and 38 cases were ABPA-B.There were 50 cases in the control group,with an average age of 45± 13 years,29 males and 21 females.There was no statistical difference in age,gender,height,course of disease,BMI and clinical manifestations between the two groups(P>0.05).2.The eosinophil counts in peripheral blood of the ABPA group was higher than that of the control group,and the difference was statistically significant(P<0.05).The serum tlgE,sIgE,and FeNO of the ABPA group were higher than those of the control group,besides the total serum IgE,sIgE,bisides FeNO of the ABPA-B group were higher than those of the ABPA-S group,and the difference was statistically significant(P<0.05).3.FeNO,tIgE,and slgE were tested individually and in combination in 67 ABPA patients when they were admitted to the hospital for ROC curve analysis.The area under the curve of FeNO,tIgE,and sIgE were 0.829(95%CI:0.756,0.901),0.924(95%CI:0.878,0.970),0.920(95%CI:0.875,0.966),and the sensitivity was 78.6%,respectively,79.1%,85.2%,the specificity was 77%,90.8%,82%,respectively.The area under the curve of the three combined detection was 0.965(95%CI:0.938,0.991),the sensitivity reached 93.6%,and the specificity reached 96.4%.4.The EOS,tIgE,sIgE and FeNO in the ABPA group after hormone treatment were significantly lower than those before the hormone treatment,and FEV1%pred was significantly improved compared with before the hormone treatment.The difference between the two groups was statistically significant(P<0.05).Before hormone therapy,FeNO and EOS are negatively correlated with FEV1%pred(r<0,P<0.05).There was no correlation between FeNO,EOS and sIgE,serum tIgE,FEV1%pred after hormone therapy(P>0.05).5.Among 67 ABPA patients,49 were effective to hormone therapy and 18 were ineffective.There was a statistically significant difference in baseline tIgE and FeNO between the effective and ineffective groups of hormone therapy(P<0.05),but there was no significant difference in tIgE and FeNO between the two groups after treatment(P>0.05).There was no statistically significant difference between baseline sIgE and post-treatment sIgE between the two groups(P>0.05).6.Using baseline FeNO,tIgE and sIgE to assess the area under the curve(AUC)of the effective and ineffective groups of hormone therapy,their area were 0.744,0.913,and 0.526,respectively.Conclusions1.FeNO are elevated in ABPA group and ABPA-B group,it may can be used as an a tool for clinical diagnosis of ABPA patients.2.The combination of FeNO,tIgE and sIgE reasonably has a certain value in diagnosing and distinguishing two different types of ABPA.3.Monitoring the levels of FeNO can reflect the control of inflammation sensitively and predict the effect of hormone therapy in ABPA treatment.Combining with serological indicators and lung function can provide a better reference for judging the efficacy of ABPA treatment.