Study On The Value Of Exminations Related Diagnosis And Efficacy Evaluation Of Allergic Bronchopulmonary Aspergillosis

Objective:Based on the consensus of experts in the diagnosis and treatment of allergic bronchopulmonary aspergillosis(ABPA),to analyze the hospital medical history of ABPA and have the study on the value of examinations related diagnosis and efficacy evaluation of ABPA.Methods:According to the HIS(Hospital Information System)of Information Computer Center in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine,the data of patients who admitted to Ruijin Hospital from January 2010 to December 2019 with discharged diagnosis of ABPA was analyzed retrospectively.We collected the basic patient information,past history,clinical manifestations,laboratory tests,chest x-ray imaging data,etc.Their role on diagnosis and follow-up of ABPA was analyzed and evaluated.At the same time,the patient's treatment strategy,its efficacy and adverse effects were followed up.The individualized performance of each treatment with related tests among different patients was also observed and evaluated.In addition,to analyze the effects of targeted drugs,patients with ABPA treated with omalizumab in Ruijin Hospital and Shanghai Pulmonary Hospital affiliated to Tongji University were screened.Results:27 patients were diagnosed with ABPA.26(96.3%)had previous chronic respiratory disease.The median serum total immunoglobulin E(t Ig E)of patients was 1070 IU/m L,with abnormal values of 23 cases(85.2%).The median serum Aspergillus-specific Ig E(s Ig E)was 4.26 k UA/L with an abnormal increase in 18 cases(90%).The median eosinophil count was 0.71×10~9/L,which was abnormally increased in 16 cases(59.3%).6(46.2%)was Aspergillus positive in allergen skin test.22 patients(81.5%)with bronchiectasis were identified by chest x-ray imaging examination.6 patients(26.1%)were positive for serum 1,3-?-D-glucan test(G test).2 patients(20%)were positive for serum galactomannan antigen(GM)test.Aspergillus was failed to be detected in patient's sputum culture.Biopsy mainly showed eosinophil infiltration(72.7%).Most of patient's treatment strategies were glucocorticoids combined with triazole anti-aspergillus drugs(55.6%).The follow-up levels of eosinophils,t Ig E,and Aspergillus s Ig E were significantly decreased when compared with those at hospitalization(p<0.05).A total of 6patients in 2 hospitals were treated with omalizumab for ABPA.After treatment,their eosinophils,t Ig E,and Aspergillus s Ig E showed a downward trend.Among them,3 patients discontinued completely and 1patient discontinued triazole.Conclusion:For patients with suspected ABPA,especially those with underlying pulmonary disease,the Aspergillus slg E level measurement is supposed to be carried out.Those patients with abnormal findings should be further detected serum t Ig E levels and Aspergillus allergen skin tests,which will be helpful for the confirmed diagnosis of ABPA.Whether ABPA is associated with bronchiectasis should be determined by CT examination.Microbial testing is of low diagnostic value for ABPA.During the follow-up of patients,peripheral blood eosinophils can be tested,and those with obvious abnormalities can be further tested for t Ig E and Aspergillus s Ig E levels to improve the efficacy of evaluation.Glucorticoid combined with antifungal therapy should be used as a first-line treatment for ABPA,At the same time,more attentions to their potential side effects are required.If ABPA patients were dependent or resistant to glucorticoid,omalizumab can be applied for them.