Abstract：
BACKGROUND: Asthma is the most common chronic respiratory disease in childhood. Aspergillus fumigatus sensitivity may be involved in the pathogenesis of asthma by leading to different clinical presentations.
OBJECTIVE: To investigate the demographic, clinical, laboratory, and radiological characteristics of A. fumigatus sensitivity in childhood asthma and identify associated risk factors and diagnostic parameters.
METHODS: A total of 259 children with asthma were included in the study, 7 (2.7%) with allergic bronchopulmonary aspergillosis (ABPA), 84 (32.4%) with A. fumigatus-sensitized asthma (Af-SA), and 168 (64.9%) with A. fumigatus-unsensitized asthma (Af-UA).
RESULTS: Aspergillus sensitivity was associated with early asthma onset and longer asthma duration. Total IgE level and asthma severity are highest in ABPA and higher in Af-SA. Absolute eosinophil count was higher, and FEV1 was lower in Af-SA and ABPA. Aspergillus fumigatus was associated with greater odds of being male (odds ratio [OR], 2.45), having atopic dermatitis (OR, 3.159), Alternaria sensitivity (OR, 10.37), and longer asthma duration (OR, 1.266). The best cut-off values for detecting A. fumigatus positivity were 363.5 IU/mL for total IgE and 455 cells/μL for absolute eosinophil count. In Af-SA compared to Af-UA, centrilobular nodules and peribronchial thickening were more common, and the bronchoarterial ratio was higher.
CONCLUSIONS: Aspergillus sensitivity is a strong allergic stimulus in asthma, leading to laboratory, structural, clinical, and functional consequences. Af-SA is a distinct asthma endotype independent of ABPA that is characterized by increased risk of severe clinical presentations and impaired lung function.
OBJECTIVE: To investigate the demographic, clinical, laboratory, and radiological characteristics of A. fumigatus sensitivity in childhood asthma and identify associated risk factors and diagnostic parameters.
METHODS: A total of 259 children with asthma were included in the study, 7 (2.7%) with allergic bronchopulmonary aspergillosis (ABPA), 84 (32.4%) with A. fumigatus-sensitized asthma (Af-SA), and 168 (64.9%) with A. fumigatus-unsensitized asthma (Af-UA).
RESULTS: Aspergillus sensitivity was associated with early asthma onset and longer asthma duration. Total IgE level and asthma severity are highest in ABPA and higher in Af-SA. Absolute eosinophil count was higher, and FEV1 was lower in Af-SA and ABPA. Aspergillus fumigatus was associated with greater odds of being male (odds ratio [OR], 2.45), having atopic dermatitis (OR, 3.159), Alternaria sensitivity (OR, 10.37), and longer asthma duration (OR, 1.266). The best cut-off values for detecting A. fumigatus positivity were 363.5 IU/mL for total IgE and 455 cells/μL for absolute eosinophil count. In Af-SA compared to Af-UA, centrilobular nodules and peribronchial thickening were more common, and the bronchoarterial ratio was higher.
CONCLUSIONS: Aspergillus sensitivity is a strong allergic stimulus in asthma, leading to laboratory, structural, clinical, and functional consequences. Af-SA is a distinct asthma endotype independent of ABPA that is characterized by increased risk of severe clinical presentations and impaired lung function.
摘要：
背景：哮喘是儿童期最常见的慢性呼吸道疾病。烟曲霉敏感性可能通过导致不同的临床表现参与哮喘的发病。
目的：调查人口统计，临床,实验室,以及儿童哮喘中烟曲霉敏感性的放射学特征，并确定相关的危险因素和诊断参数。
方法：本研究共纳入259名哮喘患儿，7例（2.7％）患有过敏性支气管肺曲霉病（ABPA），84例（32.4%）患有烟曲霉致敏哮喘（Af-SA），和168例（64.9%）与烟曲霉未敏化哮喘（Af-UA）。
结果：曲霉敏感性与哮喘发病早期和哮喘持续时间较长有关。总IgE水平和哮喘严重程度在ABPA中最高，在Af-SA中更高。嗜酸性粒细胞绝对计数较高，Af-SA和ABPA中FEV1较低。烟曲霉与男性的几率更大(优势比[OR]，2.45),患有特应性皮炎（或，3.159),链格孢菌敏感性(OR，10.37),和更长的哮喘持续时间(或，1.266).检测烟曲霉阳性的最佳截断值对于总IgE是363.5IU/mL,对于绝对嗜酸性粒细胞计数是455细胞/μL。在Af-SA与Af-UA相比，小叶中央结节和支气管周围增厚更为常见，支气管动脉比率较高。
结论：曲霉菌敏感性是哮喘的强过敏性刺激，通向实验室,结构,临床,和功能后果。Af-SA是一种独立于ABPA的独特的哮喘内生型，其特征是严重临床表现和肺功能受损的风险增加。
目的：调查人口统计，临床,实验室,以及儿童哮喘中烟曲霉敏感性的放射学特征，并确定相关的危险因素和诊断参数。
方法：本研究共纳入259名哮喘患儿，7例（2.7％）患有过敏性支气管肺曲霉病（ABPA），84例（32.4%）患有烟曲霉致敏哮喘（Af-SA），和168例（64.9%）与烟曲霉未敏化哮喘（Af-UA）。
结果：曲霉敏感性与哮喘发病早期和哮喘持续时间较长有关。总IgE水平和哮喘严重程度在ABPA中最高，在Af-SA中更高。嗜酸性粒细胞绝对计数较高，Af-SA和ABPA中FEV1较低。烟曲霉与男性的几率更大(优势比[OR]，2.45),患有特应性皮炎（或，3.159),链格孢菌敏感性(OR，10.37),和更长的哮喘持续时间(或，1.266).检测烟曲霉阳性的最佳截断值对于总IgE是363.5IU/mL,对于绝对嗜酸性粒细胞计数是455细胞/μL。在Af-SA与Af-UA相比，小叶中央结节和支气管周围增厚更为常见，支气管动脉比率较高。
结论：曲霉菌敏感性是哮喘的强过敏性刺激，通向实验室,结构,临床,和功能后果。Af-SA是一种独立于ABPA的独特的哮喘内生型，其特征是严重临床表现和肺功能受损的风险增加。
