固定气流阻塞支气管扩张症患者肺部微生物组的临床影响:一项前瞻性队列研究。

IF 5.8 2区 医学 Q1 Medicine Respiratory Research Pub Date : 2024-08-14 DOI:10.1186/s12931-024-02931-x
Yen-Fu Chen, Hsin-Han Hou, Ning Chien, Kai-Zen Lu, Chieh-Hua Lin, Yu-Chieh Liao, Kuo-Lung Lor, Jung-Yien Chien, Chung-Ming Chen, Chung-Yu Chen, Shih-Lung Cheng, Hao-Chien Wang, Po-Ren Hsueh, Chong-Jen Yu
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引用次数: 0

摘要

背景:气流阻塞是支气管扩张症疾病严重程度和预后的标志。固定气流阻塞(FAO)支气管扩张症患者的肺微生物群、气道炎症和预后之间的关系仍不清楚。本研究探讨了支气管扩张症患者(有固定气流阻塞和无固定气流阻塞)与慢性阻塞性肺病(COPD)患者之间的相互作用,并将其与慢性阻塞性肺病患者进行了比较:这项在台湾开展的前瞻性观察研究招募了支气管扩张症或慢性阻塞性肺病患者。为了分析肺部微生物组和评估炎症标志物,研究人员采集了支气管肺泡灌洗液(BAL)样本进行 16S rRNA 基因测序。研究队列由 181 名患者组成:其中 86 人患有慢性阻塞性肺病,46 人患有支气管扩张症,49 人患有支气管扩张症和 FAO(经肺活量测定证实):结果发现:无论是否患有FAO,支气管扩张症患者的微生物组特征都很相似,即α多样性降低,变形杆菌占主导地位,这与慢性阻塞性肺病患者截然不同,后者表现出更多的固缩菌、更高的多样性和更多的共生类群。此外,与无FAO的慢性阻塞性肺病和支气管扩张症患者相比,有FAO的支气管扩张症患者病情更严重,恶化风险更高。研究发现,铜绿假单胞菌的存在与气道中性粒细胞炎症(如白细胞介素[IL]-1β、IL-8和肿瘤坏死因子-α[TNF]-α)的增加以及支气管扩张的严重程度之间存在明显的相关性,这可能会增加病情恶化的风险。此外,在患有 FAO 的支气管扩张症患者中,采用了 ROSE(放射学、阻塞、症状和暴露)标准,根据吸烟史将患者分为 ROSE(+)或 ROSE(-)。这种分类方法凸显了ROSE(-)和ROSE(+)患者在临床特征、炎症特征和微生物组轻微变化方面的差异,表明患有FAO的支气管扩张症患者群体中存在不同的内型:结论:根据ROSE标准的定义,患有FAO的支气管扩张症患者可能表现出两种不同的内型,其特点是疾病严重程度更高,肺部微生物组与无FAO的支气管扩张症更相似,而与慢性阻塞性肺病更相似。铜绿假单胞菌定植与气道嗜中性粒细胞炎症增加以及疾病严重程度之间的显著相关性强调了微生物模式的临床意义。这一发现加强了这些模式在患有 FAO 的支气管扩张症的进展和恶化中的潜在作用。
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The clinical impacts of lung microbiome in bronchiectasis with fixed airflow obstruction: a prospective cohort study.

Background: Airflow obstruction is a hallmark of disease severity and prognosis in bronchiectasis. The relationship between lung microbiota, airway inflammation, and outcomes in bronchiectasis with fixed airflow obstruction (FAO) remains unclear. This study explores these interactions in bronchiectasis patients, with and without FAO, and compares them to those diagnosed with chronic obstructive pulmonary disease (COPD).

Methods: This prospective observational study in Taiwan enrolled patients with either bronchiectasis or COPD. To analyze the lung microbiome and assess inflammatory markers, bronchoalveolar lavage (BAL) samples were collected for 16S rRNA gene sequencing. The study cohort comprised 181 patients: 86 with COPD, 46 with bronchiectasis, and 49 with bronchiectasis and FAO, as confirmed by spirometry.

Results: Patients with bronchiectasis, with or without FAO, had similar microbiome profiles characterized by reduced alpha diversity and a predominance of Proteobacteria, distinctly different from COPD patients who exhibited more Firmicutes, greater diversity, and more commensal taxa. Furthermore, compared to COPD and bronchiectasis without FAO, bronchiectasis with FAO showed more severe disease and a higher risk of exacerbations. A significant correlation was found between the presence of Pseudomonas aeruginosa and increased airway neutrophilic inflammation such as Interleukin [IL]-1β, IL-8, and tumor necrosis factor-alpha [TNF]-α, as well as with higher bronchiectasis severity, which might contribute to an increased risk of exacerbations. Moreover, in bronchiectasis patients with FAO, the ROSE (Radiology, Obstruction, Symptoms, and Exposure) criteria were employed to classify individuals as either ROSE (+) or ROSE (-), based on smoking history. This classification highlighted differences in clinical features, inflammatory profiles, and slight microbiome variations between ROSE (-) and ROSE (+) patients, suggesting diverse endotypes within the bronchiectasis with FAO group.

Conclusion: Bronchiectasis patients with FAO may exhibit two distinct endotypes, as defined by ROSE criteria, characterized by greater disease severity and a lung microbiome more similar to bronchiectasis without FAO than to COPD. The significant correlation between Pseudomonas aeruginosa colonization and increased airway neutrophilic inflammation, as well as disease severity, underscores the clinical relevance of microbial patterns. This finding reinforces the potential role of these patterns in the progression and exacerbations of bronchiectasis with FAO.

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来源期刊
Respiratory Research
Respiratory Research RESPIRATORY SYSTEM-
CiteScore
9.70
自引率
1.70%
发文量
314
审稿时长
4-8 weeks
期刊介绍: Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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