变应性支气管肺曲霉病的CT表现——附17例分析

目的探讨变应性支气管肺曲霉病(ABPA)的CT特点,进一步提高对该病的认识。方法回顾性分析17例AB-PA的CT表现,所有的患者均按目前的ABPA诊断标准进行诊断。结果 17例患者均有中心性支气管扩张征象,13例并支气管黏液栓形成,为分支状或挤牙膏状或长管状"Y"形,7例以树芽征为主要表现的小叶中心结节形成,9例有斑片状浸润影,2例随访见中心性支气管扩张有游走性。结论变应性支气管肺曲霉病(ABPA)的CT表现相对有特征性,以中心性支气管扩张为主,常伴有较高密度的支气管腔内黏液栓形成,结合临床一般能做出诊断。     

血清和支气管肺泡灌洗液GM试验对非粒细胞缺乏患者不同类型肺曲霉病的诊断价值分析CSCD

目的探讨血清和支气管肺泡灌洗液(BALF)GM试验在不同类型肺曲霉病中的诊断价值,并确定BALF GM试验对常见肺曲霉病的最优cut-off值。方法收集2017年1月至2021年3月在重庆医科大学附属第一医院诊断为肺曲霉病且同时送检过血清和BALF GM试验的非粒细胞缺乏患者资料146例,其中侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)97例,慢性肺曲霉病(chronic pulmonary aspergillosis,CPA)39例,变应性支气管肺曲霉病(allergic bronchopulmonary aspergillosis,ABPA)10例;并随机选取132例同时期患有其他类型肺部疾病者作为对照组。统计分析血清和BALF GM试验对不同类型肺曲霉病的诊断性能。结果在非粒细胞缺乏患者中,BALF GM试验对IPA和CPA诊断的最优cut-off值分别为1.0和0.91,敏感性分别为74.2%和74.4%,特异性分别为83.3%和81.1%,但对ABPA的诊断作用有限(AUC=0.648);在cut-off值为0.5时,血清GM试验对IPA和CPA的诊断敏感性分别为41.2%和10.3%,对ABPA的诊断价值较差(AUC<0.5)。结论在非粒细胞缺乏患者中,BALF GM试验对IPA和CPA的诊断均有良好辅助诊断作用,但对ABPA的诊断作用有限;血清GM试验对IPA和CPA的诊断敏感性较低,对ABPA的诊断价值更差。     

以肺部病变为主要表现的韦格纳肉芽肿1例并文献复习

目的:促进韦格纳肉芽肿的早期诊断和治疗,提高患者的生存率.方法:回顾性分析我院收治的1例韦格纳肉芽肿患者的发病诊治过程的临床资料并结合文献进行复习.结果:入院后行胸部CT、抗中性粒细胞胞浆抗体(ANCA)等检查,明确诊断后给予糖皮质激素、细胞毒类药物等治疗后短期缓解,5个月后死亡.结论:韦格纳肉芽肿的临床表现多种多样,诊断困难,实验室检查无特异性,临床上对于多系统受累的疾病应警惕此病,应结合患者临床表现及辅助检查做出早期诊断,及早治疗,从而提高患者的生存率.     

早期肺癌诊断中PET/CT的应用价值

目的:探讨PET/CT在早期肺癌诊断中的应用价值.方法:应用PET/CT对16例肺部孤立性病灶进行PET/CT检查,手术切除病灶组织送病理检查,以判断诊断符合率与细胞类型.结果:16例肺病灶患者PET/CT检查与手术切除组织病理结果相比较,诊断符合率为87.5%,其中腺癌13例(包括细支气管肺泡细胞癌6例),鳞癌2例,肺粘膜相关B细胞淋巴瘤1例.结论:结合临床症状,PET/CT检查能够准确的对肺癌做出早期诊断,及早治疗,改善患者预后     

支气管哮喘患者IgE水平与家族史相关

本文通过59例外源性支气管哮喘患者（以下简称哮喘）与36例健康对照者的家系调查及血清总IgE、特异性IgE阳性率的测定,发现哮喘组的血清总IgE平均值(714.0u/ml) 明显高于对照组(275.1u/ml),血清总IgE超常例数百分率（61.0%）也明显高于对照组（8.3%）,证明IgE参与了哮喘的发病。哮喘组阳性家族史患者与鹰性家族史患者比较,发现前者血清总IgE平均值（921.9u/ml）明显高于后者(410.6u/ml),血清总IgE超常例数百分率也是前者(80.0%)高于后者(33.3%);特异性IgE阳性率（前者为62.9%,后者为29.2%）也具有同样特点。数据表明血清总IgE及特异性IgE与哮喘的遗传与发病相关。血清总IgE升高与特异性IgE阳性呈不一致分布提示两者可能有不同的遗传调节方式。     

急性肠系膜缺血性疾病的CT影像特征及诊断价值

目的:总结急性肠系膜缺血(AMI)的临床资料及CT影像特征并探讨多层螺旋CT(multi-slice spiral computed tomography,MSCT)对该病的诊断价值。方法:回顾性分析经临床或手术证实的54例AMI患者的CT和临床资料,包括其发病时间、主要症状、体征、相关实验室检查指标,评价并分析异常的MSCT表现。结果:54例均以非特异性腹痛为首发症状,其中肠系膜上静脉血栓形成(SMVT)38例,肠系膜上动脉栓塞(SMAE)12例,肠系膜上动脉血栓形成(SMAT)4例。MSCT诊断AMI的直接征象为血管内充盈缺损(43例),间接征象包括:肠壁增厚35例,"靶征"16例,肠管扩张20例,"缆绳征"22例,肠壁积气征13例,"薄壁样征"12例,腹腔积液34例。结论:AMI的临床表现缺乏特异性,MSCT检查可准确诊断AMI并明确缺血程度、范围,对指导治疗具有较高的应用价值。     

血清S1P、SFRP1、TIM4、SFRP5与成人支气管哮喘急性发作期患者肺功能、气道炎症和治疗后再次急性复发的关系

摘要 目的：观察血清分泌型卷曲相关蛋白1（SFRP1）、分泌型卷曲相关蛋白5（SFRP5）、1-磷酸鞘氨醇（S1P）、T细胞免疫球蛋白域及黏蛋白域蛋白4（TIM4）与成人支气管哮喘急性发作期患者肺功能、气道炎症和治疗后再次急性复发的关系。方法：选择火箭军特色医学中心2016年7月~2020年8月期间收治的120例成人支气管哮喘患者,其中47例缓解期患者纳为缓解组,73例急性发作期患者纳为发作组。对比发作组、缓解组血清S1P、SFRP1、TIM4、SFRP5水平、肺功能[第1秒用力呼气容积（FEV₁）、用力肺活量（FVC）、FEV₁/FVC]、气道炎症[血清总免疫球蛋白E（IgE）、痰嗜酸粒细胞、呼出气一氧化氮（FeNO）、血嗜酸粒细胞],治疗结束后以门诊复查或电话的形式进行随访1年,根据1年内是否再次急性复发分组,分为复发组和未复发组,对比复发组和未复发组的血清S1P、SFRP1、TIM4、SFRP5水平。结果：发作组的S1P、SFRP1、TIM4高于缓解组,SFRP5低于缓解组（P<0.05）。发作组的FEV₁、FVC、FEV₁/FVC低于缓解组（P<0.05）。发作组的血清总IgE、嗜酸粒细胞、FeNO、血嗜酸粒细胞高于缓解组（P<0.05）。Pearson相关性分析结果显示,S1P、SFRP1、TIM4与FEV₁、FVC、FEV₁/FVC呈负相关（P<0.05）,而与血清总IgE、嗜酸粒细胞、FeNO、血嗜酸粒细胞均呈正相关（P<0.05）。SFRP5与FEV₁、FVC、FEV₁/FVC呈正相关（P<0.05）,而与血清总IgE、嗜酸粒细胞、FeNO、血嗜酸粒细胞均呈负相关（P<0.05）。复发组的S1P、SFRP1、TIM4高于未复发组,SFRP5低于未复发组（P<0.05）。结论：成人支气管哮喘急性发作期患者S1P、SFRP1、TIM4水平异常升高,SFRP5异常降低,且与肺功能、气道炎症、再次急性复发均有一定关系。     

肺淋巴瘤的CT表现

目的：肺部淋巴瘤可为原发,亦可为其他部位淋巴瘤的肺部浸润,临床上很少见。准确的影像学诊断对于采取及时的治疗措施具有重要意义,然而该病影像学表现复杂多变,容易与多种其他肺部病变混淆,以往文献对于肺部淋巴瘤的CT影像特征性表现报道不多,本文旨在探讨肺部淋巴瘤的特征性CT表现,以提高该痛影像诊断的准确率。方法：回顾性分析17例病理证实的肺淋巴瘤患者CT资料,分析特征性影像表现。结果：17例中多发者13例,单发者4例。叶段性或斑片状实变影13例,多发结节影13例,肿块状实变影8例,具有两种以上病灶的12例。特征性的征象有：病灶密度均匀（88．2％,15／17）、病灶边缘模糊（82．3％,14／17）、支气管气相（64．7％,11／17）、支气管血管柬增厚（58．8％,10／17）和CT血管造影征（41．2％,7／17）,对诊断有较大意义。结论：肺部淋巴瘤CT表现以多发、多形态病变居多,具有一定特征性影像表现,密度均匀、边缘模糊的实变、团块或结节影,具有支气管气相、支气管血管束增厚、增强扫描可见CT血管造影征等表现可高度提示本病的可能,结合病史、临床表现以及实验室检查,可提高本病的诊断准确率,对于及时开展有效的治疗措施、改善患者预后具有重要的临床意义。     

miR-1165-3p、miR-145水平在支气管哮喘患者中的表达及其临床意义

摘要 目的：探讨微小RNA（MicroRNA,miR）-1165-3p、miR-145水平在支气管哮喘患者中的表达及其临床意义。方法：收集2021年1月-2022年3月中国人民解放军总医院第六医学中心62例支气管哮喘患者作为研究组,其中轻度急性发作27例,中度急性发作22例,重度急性发作13例。另收集同时期、同年龄段30例健康体检者作为对照组。采用实时荧光定量PCR（RT-PCR）检测各组血清miR-1165-3p、miR-145表达水平。采用Spearman相关分析不同程度支气管哮喘患者与血清miR-1165-3p、miR-145之间的相关性。通过受试者工作特征（ROC）分析血清miR-1165-3p、miR-145表达水平对不同程度支气管哮喘的诊断效能。结果：与对照组相比,研究组中白细胞介素-6（IL-6）、嗜酸性粒细胞、总免疫球蛋白E（IgE）水平显著升高,第1秒用力呼气容积（FEV₁）占预测值百分比（FEV₁%）则显著降低,差异均有统计学意义（P＜0.05）。不同严重程度支气管哮喘患者（轻度、中度、重度）血清miR-1165-3p、miR-145表达水平均高于健康对照组,支气管哮喘越严重,其表达水平越高,且组间、组内比较差异均有统计学意义（P＜0.05）。Spearman相关分析显示,miR-1165-3p、miR-145、IL-6表达水平与哮喘严重程度呈正相关（P＜0.05）,FEV₁%与哮喘严重程度呈负相关（P＜0.05）,嗜酸性粒细胞、总IgE与哮喘严重程度无相关性（P＞0.05）。对轻度、中度、重度急性支气管哮喘发作的诊断效能显示：血清miR-1165-3p的曲线下面积（AUC）（0.95CI）分别为3.085（0.326～29.221）、0.712（0.611～0.829）、0.755（0.602～0.948）。血清miR-145的AUC（0.95CI）分别为0.833（0.708～0.979）、0.754（0.590～0.964）、0.816（0.671～0.993）。结论：血清miR-1165-3p、miR-145表达水平具有较高的诊断效能,支气管哮喘越严重,诊断的特异性越高,可作为支气管哮喘严重程度的无创诊断指标。     

非粒细胞缺乏患者侵袭性气道曲霉病19例临床分析

目的提高对非粒细胞缺乏患者侵袭性气道曲霉病的认识及诊疗水平。方法回顾性分析19例非粒细胞缺乏患者侵袭性气道曲霉病的危险因素,临床特征,影像学,支气管镜下表现,治疗及预后资料。结果 19例患者男性13例(68%),女性6例(32%),年龄33~76岁、平均(57.32±11.69)岁。既往患慢性阻塞性肺疾病4例(21%),糖尿病4例(21%),肺癌3例(16%),高血压病3例(16%),陈旧性肺结核病2例(11%),支气管扩张2例(11%),肺血管炎1例(5%),间质性肺病1例(5%);其中2例患者有3种以上基础疾病,7例有2种基础疾病。常见的临床症状为咳嗽,气急(100%),发热(74%);影像学改变早期主要为沿气道分布的结节,渗出,12例患者入院后胸部CT显示病灶明显进展;支气管镜下改变以混合型为主;首选治疗药物为伏立康唑针;总疗程均大于6周,最长22周;死亡率为16%,其中1例因经济原因治疗4周后自行停药,8周后再次因为肺部出现新病灶病情进展再次入院。结论侵袭性气道曲霉病是侵袭性肺曲霉病的一种少见类型,在非粒细胞缺乏的患者身上常常漏诊、误诊,提高对本病的认识,及早进行支气管镜检查,早期诊断及全身治疗可以减少患者的死亡率。     

Pulmonary Aspergillus Overlap Syndromes

Background

Broadly, there are three main categories in pulmonary aspergillosis: chronic forms of aspergillosis; allergic bronchopulmonary aspergillosis; and invasive aspergillosis (IPA). IPA has been further subdivided into angioinvasive and airway-invasive aspergillosis. Aspergillus overlap syndromes is defined as the occurrence of more than one form aspergillus disease in a single individual.

Objectives

To help clinicians correctly deal with AOS.

Methods

Retrospectively study the clinical findings of nine patients presenting with AOS.

Results

Four cases were diagnosed as angioinvasive aspergillosis complicated with ABPA, three cases as IPA overlap aspergilloma, and two cases as ABPA with AWIA. All the patients presented with cough and expectoration. In three patients with IPA overlap aspergilloma, two had hemoptysis, two had wheezing and fever. All of patients with IPA overlap ABPA had wheezing, dyspnea, and fever, three had sputum plugs, two had hemoptysis, and five patients had mucopurulent discharge and rhonchi in auscultation. Their total IgE ranged from 129 to 2124 IU/ml (676.5 ± 557.33 IU/ml). Fungal culture in sputum showed A. Fumigatus in three patients. All the six patients with IPA overlap ABPA applied steroid therapy and antifungal therapy. Three of them received two or more antifungal drugs successively, and three received combinational therapy. All the patients improved except one diagnosed ABPA overlap IPA.

Conclusions

Clinical manifestation of AOS is not typical. Poor first-line therapeutic effects and complicated diagnosis criteria require clinicians to be aware of AOS when facing patients with aspergillosis.

     

Allergic Bronchopulmonary Aspergillosis with Aspergilloma: An Immunologically Severe Disease with Poor Outcome

Background and Aims

The association between allergic bronchopulmonary aspergillosis (ABPA) and aspergilloma has been proposed as a severe form of ABPA. However, this conclusion is based on single-patient case reports. In this study, we describe the clinical details and immunological findings of this association and compare patients of ABPA with aspergilloma and those without.

Methods

This is a retrospective analysis of data of patients with ABPA managed in the Chest Clinic. We compared the clinical, radiological and immunological profile of patients with ABPA and central bronchiectasis, with and without the presence of aspergilloma on HRCT scan.

Results

There were 98 men and 81 women with a mean (SD) age of 33.6 (12.2) years. Eight patients were diagnosed to have aspergilloma. Sputum cultures grew Aspergillus fumigatus in all these eight patients. The aspergilloma was solitary in six patients, and two each in two patients. Patients with aspergilloma had higher IgE levels (both total and A. fumigatus specific) than those without aspergilloma. Bronchiectasis was also more extensive in patients with aspergilloma. Overall, 70?% of the ABPA patients experienced relapse during the median (interquartile range) follow-up of 27 (19?C39) months. The number of relapses was significantly higher in patients with aspergilloma (p?=?0.0001). On a multivariate linear regression analysis, high-attenuation mucus and aspergilloma were independent predictors of relapse frequency.

Conclusions

The concurrent presentation of ABPA and aspergilloma is associated with an immunologically severe disease and risk of recurrent relapses.     

Diagnosis and treatment of allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a rare form of asthma that is most common in corticosteroid-dependent asthmatic patients and cystic fibrosis patients. It is caused by an abnormal T-helper class 2 response of the host to Aspergillus antigens. Although signs and symptoms of typical asthma are usually present with ABPA, unusual features such as fever, expectoration of brown plugs, and central bronchiectasis with or without mucoid impaction on chest radiographs may be present. ABPA is important to diagnose because inadequate therapy may lead to permanent lung destruction. Corticosteroids are the drug of choice for ABPA; however, the doses required are often greater than for routine asthma and corticosteroid dependence is not unusual. Azole therapy appears to have an adjunctive role in treatment in terms of improving signs and symptoms of the disease and demonstrating a corticosteroid-sparing effect.     

Immunoreactivity of antigen extracts of Aspergillus fumigatus isolated from different sources

Allergic bronchopulmonary aspergillosis (ABPA) is the result of hypersensitivity to Aspergillus antigens in patients with long-standing atopic asthma. In the present study mycelial and culture filtrate antigens from Aspergillus fumigatus cultures isolated from diverse sources were tested against sera of 10 ABPA patients and 10 control individuals by an ELISA methodology. The results indicate higher antibody reactivity against both antigens in the sera of ABPA patients, while culture filtrate antigens also gave non-specific reactivity with control sera. Mycelial extracts, in general, were useful in the diagnosis of ABPA.     

HLA‐DRB1 and HLA–DQB1 genes on susceptibility to and protection from allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity pulmonary disease that affects both patients with cystic fibrosis (CF) and those with asthma. HLA‐DRB1 alleles have previously been associated with ABPA–CF susceptibility; however, HLA‐DQB1 allele associations have not been clearly established. The aim of the present study was to investigate HLA class II associations in patients with ABPA–CF and determine their roles in susceptibility or protection. Patients with ABPA–CF, patients with CF without ABPA, patients with asthma without ABPA (AST), and healthy controls were included in this study. DNA was extracted by automatic extractor. HLA‐DRB1 and ‐DQB1 genotyping was performed by the Luminex PCR‐SSOP method (One Lambda, Canoga Park, CA, USA). Allele specific PCR‐SSP was also performed by high‐resolution analysis (One Lambda). Statistical analysis was performed with SSPS and Arlequin software. Both HLA‐DRB1*5:01 and ‐DRB1*11:04 alleles occurred with greater frequency in patients with ABPA–CF than in those with AST and CF and control subjects, corroborating previously published data. On the other hand, analysis of haplotypes revealed that almost all patients with ABPA–CF lacking DRB1*15:01 or DRB1*11:04 carry either DRB1*04, DRB1*11:01, or DRB1*07:01 alleles. In the HLA‐DQB1 region, the HLA‐DQB1*06:02 allele occurred more frequently in patients with ABPA–CF than in those with AST and CF and healthy controls, whereas HLA‐DQB1*02:01 occurred less frequently in patients with ABPA–CF. These data confirm that there is a correlation between HLA‐DRB1*15:01, –DRB1*11:04, DRB1*11:01, –DRB1*04 and –DRB1 * 07:01 alleles and ABPA–CF susceptibility and suggest that HLA‐DQB1*02:01 is an ABPA–CF resistance allele.     

Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in allergic bronchopulmonary aspergillosis.

The etiology of allergic bronchopulmonary aspergillosis (ABPA) is not well understood. A clinical phenotype resembling the pulmonary disease seen in cystic fibrosis (CF) patients can occur in some individuals with ABPA. Reports of familial occurrence of ABPA and increased incidence in CF patients suggest a possible genetic basis for the disease. To test this possibility, the entire coding region of the cystic fibrosis transmembrane regulator (CFTR) gene was analyzed in 11 individuals who met strict criteria for the diagnosis of ABPA and had normal sweat electrolytes (< or = 40 mmol/liter). One patient carried two CF mutations (deltaF508/R347H), and five were found to carry one CF mutation (four deltaF508; one R117H). The frequency of the deltaF508 mutation in patients with ABPA was significantly higher than in 53 Caucasian patients with chronic bronchitis (P < .0003) and the general population (P < .003). These results suggest that CFTR plays an etiologic role in a subset of ABPA patients.     

Allergic bronchopulmonary aspergillosis (ABPA): Studies on the general and specific humoral response

Serum specimens from 138 patients suffering from chronic respiratory disorders including 63 with allergic bronchopulmonary aspergillosis (ABPA), 20 with suspected ABPA, 25 with pulmonary tuberculosis, 14 with bronchial asthma, 10 with chronic bronchitis and 6 with miscellaneous pulmonary conditions were studied for circulating antibodies to Aspergillus. The ammonium sulfate test was employed with an iodine-125 labeled mycelial component derived from Aspergillus fumigatus. When compared to normal controls from the same area, this test indicated that sera from 82 per cent of patients with ABPA had elevated binding titers to the radiolabeled antigenic component. Immunodiffusion using a culture filtrate antigen from A. fumigatus, revealed precipitating antibody to this fungus in 89 per cent of sera from ABPA patients. The majority of patients with ABPA demonstrated marked elevations of total serum IgE, moderate elevations of serum IgA and IgD and slightly increased levels of IgG and IgM.This study was supported in part by Research Grant AI 10940 from the National Institutes of Health and by NHLI Contract N01-HL-3-2942(B), and forms a part of the Ph.D. thesis submitted by Z.U.K. to the University of Delhi.     

An alternate method of classifying allergic bronchopulmonary aspergillosis based on high-attenuation mucus

Background and Aim

Allergic bronchopulmonary aspergillosis (ABPA) is classified radiologically based on the findings of central bronchiectasis (CB) and other radiologic features (ORF). However, the long-term clinical significance of these classifications remains unknown. We hypothesized that the immunological activity and outcomes of ABPA could be predicted on HRCT chest finding of high-attenuation mucus (HAM), a marker of inflammatory activity. In this study, we evaluate the severity and clinical outcomes of ABPA with different radiological classifications.

Methods

Patients were classified based on CT chest findings as: (a) serologic ABPA (ABPA-S) and ABPA-CB; (b) ABPA-S, ABPA-CB, and ABPA-CB-ORF; and, (c) ABPA-S, ABPA-CB and ABPA-CB-HAM. The clinical, spirometric and serological (total and A fumigatus specific IgE levels, eosinophil count) severity of the disease and clinical outcomes in various classifications were analyzed.

Results

Of the 234 (123 males, 111 females; mean age, 34.1 years) patients, 55 (23.5%) had normal HRCT, 179 (76.5%) had CB, 49 (20.9%) had HAM, and 27 (11.5%) had ORF. All immunological markers were consistently higher in the HAM classification, while in other classifications these findings were inconsistent. On multivariate analysis, the factors predicting frequent relapses were presence of HAM (OR 7.38; 95% CI, 3.21–17.0) and CB (OR 3.93; 95% CI, 1.63–9.48) after adjusting for ORF.

Conclusions

The classification scheme based on HAM most consistently predicts immunological severity in ABPA. Central bronchiectasis and HAM are independent predictors of recurrent relapses in ABPA. Hence, HAM should be employed in the radiological classification of ABPA.     

Specific antibodies to recombinant allergens of Aspergillus fumigatus in cystic fibrosis patients with ABPA

Background

Aspergillus fumigatus, a widely distributed fungus, has been implicated in causing life threatening infections as well as severe asthma and allergic diseases in man. Allergic affliction like allergic bronchopulmonary aspergillosis (ABPA) is a disabling lung disease frequently seen in patients with asthma and cystic fibrosis. Immunodiagnosis of the former is comparatively easier due to the availability of purified antigens and sensitive methods. However, this is not true with cystic fibrosis patients where the prevalence of ABPA is fairly high and the morbidity and mortality are significant.

Methods

In the present study, we have evaluated purified recombinant allergens from A. fumigatus, namely Asp f 1, f 2, f 3, f 4, and f 6 using ELISA and a semi-automated method (ImmunoCAP). We studied 17 patients each from cystic fibrosis with ABPA, and cystic fibrosis with asthma, 22 cystic fibrosis with no ABPA or asthma, and 11 age matched controls.

Results

The results indicate that no antigen, antibody or method is capable of differentiating cystic fibrosis (CF) with ABPA from other CF patients, although some allergens showed strong reaction or showed more prevalence among the patients studied.

Conclusion

When results of several allergens such as Asp f 1, f 2, f 3, f 4, and f 6 in their binding to IgA, IgG, and IgE antibodies were analyzed, a more strong discrimination of CF patients with ABPA was possible from the other groups studied.