Clinical Characteristics Of Aspergillus Fumigatus-Sensitized Asthma And Allergic Bronchopulmonary Aspergillosis

Objective: To investigate the clinical characteristics of Aspergillus fumigatus(A.f)-sensitized asthma and allergic bronchopulmonary aspergillosis(ABPA),which provides a foundation for the diagnosis and differential diagnosis of A.f-sensitized asthma and ABPA,as well as the prevention of ABPA.Methods: This was a single-center retrospective case-control study.Collected the clinical data of patients who visited the Department of Respiratory and Critical Care Medicine,Zhongnan Hospital of Wuhan University from December 2018 to May 2022.The patients were divided into three groups: ABPA group,A.f-sensitized asthma group and house dust mite(HDM)-sensitized asthma group.Analyzed the differences and correlations among clinical indicators(lung function,blood routine examination)in the three groups,and ev aluated the risk factors for the development of ABPA in A.f-sensitized asthma.For statistical analysis,metrological data was tested by t-test or Wilcoxon Mann-Whitney test.Classification variables by chi-square test or Fisher’s exact test.Pearson correlation analysis for normal distribution data.Spearman correlation analysis for skewed distribution data.Influencing factor analysis was performed using multivariate logistic regression analysis.The receiver operating characteristic(ROC)cu rve was made,the area under the ROC curve(AUC)was calculated,and the sensitivity and specificity of the model were evaluated.Results: A total of 122 patients were included,including 64 males(52.5%)and 58 females(47.5%).The age range was 3 to 89 y ears.The median age was44 years.The average age was 41.8 years.Among them,there were 48 ABPA,35 A.f-sensitized asthma and 39 HDM-sensitized asthma.Compared with patients with A.f-sensitized asthma,the fractional exhaled nitric oxide(FeNO),eosinophils%(EO%),eosinophils(EO),A.f-specific Immunoglobulin E(s Ig E),and s Ig E to total Ig E(t Ig E)ratio(s Ig E/t Ig E)were higher in ABPA patients,the difference s were statistically significant(P <0.001).In all patients,t Ig E was positively corr elated with EO%(r=0.206,P <0.05)and EO(r=0.302,P <0.001).s Ig E/t Ig E was negatively correlated with one-second rate(FEV1/FVC%)(r =-0.256,P <0.01).The percent age of predicted forced vital capacity [FVC(%)] was negatively correlated with FeNO(r =-0.184,P <0.05).In the ABPA group,the percentage of predicted peak expiratory flow[PEF(%)] was negatively correlated with FeNO(r=-0.295,P <0.05).In the HDM-sensitized asthma group,FeNO was positively correlated with EO%(r=0.49,P <0.01)and EO(r=0.548,P <0.001).The results of logistic regression analysis showed that FeNO and EO were the influencing factor s for the development of ABPA in A.f-sensitized asthma.ROC cu rve analysis resul ts showed that A.f-s Ig E(cutoff,4.108;AUC=0.749;CI,0.632～0.867),s Ig E/t Ig E(cutoff,0.0026;AUC=0.749;CI,0.631～0.868),FeNO(cutoff,55.5;AUC=0.794;CI,0.687～0.900),EO%(cutoff,8.70;AUC=0.806;CI,0.709～0.903)and EO(cutoff,0.815;AUC=0.865;CI,0.779～0.950)had differential diagnostic value in A.f-sensitized asthma and ABPA.The combination of FeNO,EO and EO% had good diagnostic efficiency in differentiating A.f-sensitized asthma from ABPA,with a sensitivity of 91.4% and a specif icity of 84.4%.Conclusion: Compared with patients with A.f-sensitized asthma,patients with ABPA have more severe eosinophil inflammation.The higher the FeNO and EO,the more likely A.f-sensitized asthma will develop into ABPA.A.f-s Ig E,s Ig E/t Ig E,FeNO,EO% and EO have differential diagnostic value in A.f-sensitized asthma and ABPA.The combination of FeNO,EO and EO% has good diagnostic efficacy in differentiating A.f-sensitized asthma from ABPA.