变态反应性支气管肺曲菌病患者血清IgE和嗜酸粒细胞水平及其临床意义

Serum IgE and Eosinophil Levels in Patients with Allergic Bronchopulmonary Aspergillosis and Their Clinical Significance

目的探讨变态反应性支气管肺曲菌病(ABPA)患者临床特征及血清免疫球蛋白E(IgE)、嗜酸粒细胞水平变化,分析其对ABPA的诊断效能。方法回顾性分析2016年3月至2024年3月收治的210例ABPA患者(观察组)和200例同期体检健康志愿者(对照组)的临床资料,比较2组血清IgE、嗜酸粒细胞计数、嗜酸粒细胞百分比。分析ABPA患者的肺功能、影像学特征,比较不同临床特征ABPA患者血清IgE、嗜酸粒细胞计数、嗜酸粒细胞百分比,并分析血清IgE与嗜酸粒细胞计数相关性。受试者工作特征曲线分析血清IgE、嗜酸粒细胞计数对ABPA的诊断效能。结果ABPA患者临床表现主要为咳嗽、咳痰、喘息;肺功能主要表现为阻塞性通气功能障碍,影像学特征以支气管扩张、黏液栓为主。ABPA患者血清烟曲霉特异性IgE为(8.76±2.97)kU/L、特异性免疫球蛋白G为(2294.85±654.13)U/mL。观察组血清IgE、嗜酸粒细胞计数、嗜酸粒细胞百分比高于对照组(P<0.05)。病程≥12个月ABPA患者血清IgE水平明显高于病程<12个月患者,有支气管扩张、黏液栓影像学征象ABPA患者嗜酸粒细胞计数水平高于无支气管扩张、黏液栓影像学征象患者(P<0.05)。ABPA患者血清IgE与嗜酸粒细胞计数呈正相关(P<0.05)。血清IgE、嗜酸粒细胞计数诊断ABPA的曲线下面积分别为0.885(95%CI:0.822,0.947)、0.829(95%CI:0.754,0.905)。结论咳嗽、咳痰、喘息是ABPA患者的主要临床症状,肺功能多表现为阻塞性通气功能障碍,影像学特征以支气管扩张和黏液栓为主,患者血清IgE、嗜酸粒细胞水平存在明显异常,可能与支气管扩张、有黏液栓及病程有关,二者对ABPA均有一定诊断价值。

Objective To investigate the clinical features,changes in serum immunoglobulin E(IgE)and eosinophilic granulocyte levels in patients with allergic bronchopulmonary aspergillosis(ABPA),and to analyze their diagnostic efficacy in ABPA.Methods Clinical data of 210 ABPA patients(observation group)admitted from March 2016 to March 2024 and 200 healthy volunteers under going physical examination during the same period(control group)were retrospectively analyzed,and serum IgE,eosinophile count and eosinophile percentage were compared between the two groups.The pulmonary function and imaging features of ABPA patients were analyzed.Serum IgE,eosinophilic count and eosinophilic percentage of ABPA patients with different clinical features were compared,and the correlation between serum IgE and eosinophilic count was analyzed.The diagnostic efficacy of serum IgE and eosinophil count in ABPA was analyzed by receiver operating characteristic(ROC)curve.Results The main clinical manifestations of ABPA patients were cough,phlegm and wheezing.Pulmonary function was mainly manifested as obstructive ventilation dysfunction,and the imaging features were mainly bronchiectasis and mucus thrombus.The specific IgE of ABPA patients was(8.76±2.97)kU/L,and the specific immunoglobulin G was(2294.85±654.13)U/mL.Serum IgE,eosinophil count and eosinophil percentage in observation group were higher than those in control group(P<0.05).The serum IgE level of ABPA patients with disease course≥12 months was significantly higher than that of patients with disease course<12 months,and the eosinophil count level of ABPA patients with bronchiectasis and imaging signs of bronchial mucous plug was higher than that of patients without bronchiectasis and imaging signs of bronchial mucous plug(P<0.05).There was a positive correlation between serum IgE and eosinophil count in ABPA patients(P<0.05).The area under the ROC curve of serum IgE and eosinophilic count for the diagnosis of ABPA were 0.885(95%CI:0.822,0.947)and 0.829(95%CI:0.754,0.905),respectively Conclusion Cough,phlegm and wheezing are the main clinical symptoms of ABPA patients,and pulmonary function is mostly manifested as obstructive ventilation dysfunction.The imaging features are mainly bronchodilation and mucus thrombus,and the levels of serum IgE and eosinophils of patients are obviously abnormal,which may be related to bronchiectasis,mucus thrombus and disease course,and have certain diagnostic value for ABPA.