| Objective1.To summarize the clinical features of patients with allergic bronchopulmonary aspergillosis(ABPA)and analyze the risk factors affecting the recurrence of ABPA in order to provide suggestions for diagnosis and treatment.2.To explore the changes of thymus and activation-regulated chemokine(TARC),macrophage-derived chemokine(MDC),interleukin-5(IL-5),and interleukin-33(IL-33)in serum of ABPA patients,and investigate their values in differential diagnosis of ABPA and allergic asthma.MethodsPart Ⅰ:A retrospective analysis of the clinical data was conducted on 82 patients diagnosed with ABPA in Shandong Provincial Qianfoshan Hospital and Qilu Hospital of Shandong University from January 2014 to December 2022.According to the presence or not of central bronchiectasis and high-attenuation mucus on chest imaging at admission,82 patients were split into serological ABPA(ABPA-S),ABPA with central bronchiectasis(ABPA-CB)and ABPA-CB with high-attenuation mucus(ABPA-CB-HAM)groups;the Kruskal-Wallis rank sum test was used to compare the general data,laboratory tests and lung function test results of the three groups.Patients who were followed up for more than 1 year were separated into two groups based on recurrence or not.Univariate analysis and multivariate logistic regression analysis were used to explore independent risk factors for ABPA recurrence.Part Ⅱ:Thirty-one patients with ABPA admitted to Shandong Provincial Qianfoshan Hospital from September 2021 to December 2022 were enrolled as the study group,while 30 allergic asthmatics and 19 healthy volunteers matched with the study group in the gender and age were enrolled as the control group.Serum levels of TARC,MDC,IL-5,IL-8 and IL-33 were detected by enzyme-linked immunosorbent assay;Kruskal-Wallis rank sum test was used to compare the levels of serum inflammatory factors among different groups;Spearman correlation analysis was used to explore the correlation between serum inflammatory factors and clinical characteristics in ABPA patients;the receiver operating characteristic curve(ROC)was used to evaluate the values of serum inflammatory factors in differential diagnosis of ABPA and allergic asthma.ResultsPart Ⅰ:1.Eighty-two patients with ABPA were included in part 1,of whom 67(81.7%)were complicated with bronchial asthma and 35(42.7%)were misdiagnosed.The most common clinical manifestations of ABPA patients included cough(98.8%),sputum(85.4%),chest tightness(78.0%),and wheezing(73.2%);the laboratory test features mainly included increased serum total IgE(100%),elevated Aspergillus fumigatus-specific IgE(100%),and elevated peripheral blood eosinophils(EOS)count(90.2%);the main imaging features included central bronchiectasis(73.2%),infiltrative shadow(57.3%),mediastinal lymph node enlargement(51.2%),and mucus plugs(35.4%);pulmonary ventilation function tests were performed in 74 patients,mainly obstructive ventilation dysfunction(71.6%).2.Serum carcinoembryonic antigen(CEA)detection was performed in 66 patients.Serum CEA levels were elevated in 34(51.5%)patients,but no tumor was found.The CEA levels of 20 patients with follow-up data were compared before and after treatment,and the serum CEA levels were found to be lower after treatment than before treatment(P<0.05).The pre-treatment serum CEA levels were higher in patients with mucus plugs than in patients without mucus plugs(P<0.05).3.There were 22 cases in the ABPA-S group,43 cases in the ABPA-CB group and 17 cases in the ABPA-CB-HAM group.Compared with the ABPA-CB group and the ABPA-S group,the ABPA-CB-HAM group had higher serum total IgE level and peripheral blood EOS count(P<0.05);compared with the ABPA-S group,the ABPA-CB-HAM group had higher Aspergillus fumigatus-specific IgE level and lower FEV1%pred(P<0.05),but there was no statistically significant difference compared with the ABPA-CB group(P>0.05).4.There were 26 cases in the recurrence group and 27 cases in the non-recurrence group.Univariate analysis suggested that the age and the incidence of HAM were higher in the recurrence group than in the non-recurrence group(P<0.05);multivariate logistic regression analysis showed that HAM(OR=5.484,95%CI:1.252-24.023,P=0.024)was an independent risk factor for recurrence in patients with ABPA.Part Ⅱ:1.The serum levels of TARC,IL-5,IL-8 and IL-33 in the ABPA group were higher than those in the allergic asthma group and healthy control group(P<0.05).Serum MDC level in ABPA group was higher than that in the healthy control group(P<0.05),but there was no statistically significant difference between ABPA group and allergic asthma group(P>0.05).2.In the ABPA group,the serum level of IL-5 was positively correlated with peripheral blood EOS count(correlation coefficient rs=0.576,P=0.001);the serum level of TARC was positively correlated with serum total IgE level(correlation coefficient rs=0.375,P=0.038).3.Serum TARC,IL-5,IL-8 and IL-33 were of medium values in differential diagnosis of ABPA and allergic asthma,with an AUC ranking of TARC>IL-33>IL-5>IL-8(0.884,0.849,0.782,0.743).Conclusions1.The clinical manifestations of ABPA were varied and atypical.Misdiagnosis and missed diagnosis occurred in the early stage of ABPA.ABPA should be alerted if patients with underlying respiratory diseases have recurrent cough and sputum,accompanied by central bronchiectasis or increased EOS count in peripheral blood.It is recommended to detect serum total IgE and Aspergillus fumigates-specific IgE as soon as possible.2.The serum levels of CEA in some ABPA patients were higher than normal and decreased after treatment.The pre-treatment serum CEA levels were higher in patients with mucus plugs than in patients without mucus plugs.3.The peripheral blood EOS count and serum total IgE level in the ABPA-CB-HAM group were higher than those in the ABPA-S group and ABPA-CB group,and the FEV1%pred in the ABPA-CB-HAM group was lower than that in the ABPA-S group.4.HAM was an independent risk factor for ABPA recurrence.5.The levels of serum TARC,IL-5,IL-8 and IL-33 in ABPA patients were higher than those in allergic asthma patients and healthy controls,suggesting that TARC,IL-5,IL-8 and IL-33 may be involved in the development of ABPA.6.Serum TARC,IL-5,IL-8 and IL-33 showed the medium diagnostic performance in differential diagnosis of ABPA and allergic asthma. |
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