Davies G, Wells A U, Doffman S, Watanabe S, Wilson R
Host Defence Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Eur Respir J. 2006 Nov;28(5):974-9. doi: 10.1183/09031936.06.00074605. Epub 2006 Aug 9.
Bronchiectasis patients are susceptible to infection with Pseudomonas aeruginosa. Isolation is associated with increased severity of disease, greater airflow obstruction and poorer quality of life. It is not known whether infection by P. aeruginosa is a marker of disease severity or contributes to disease progression. Consecutive non-cystic fibrosis adult bronchiectasis outpatients (n = 163) with multiple sputum cultures and follow-up pulmonary function tests were designated, according to isolation of P. aeruginosa, as "never infected" (group 1; n = 67), "intermittently isolated" (group 2; n = 82) and "chronically infected" (group 3; n = 14). Based upon change in forced expiratory volume in one second (FEV(1)) % predicted levels at >or=2 yrs after presentation, longitudinal behaviour was characterised as "improvement" (>or=10% rise), "decline" (>or=10% fall) or "stability". Baseline pulmonary-function tests and longitudinal behaviour were examined in relation to pseudomonas status. There was no difference between the groups in age, sex, smoking habit or length of follow-up. Baseline FEV(1) levels were highest in group 1 (mean+/-sd: 77.4+/-24.3) and higher in group 2 (67.3+/-25.7) than in group 3 (55.2+/-18.5). The same significant trends were seen for baseline FEV(1)/forced vital capacity ratios and diffusing capacity of the lung for carbon monoxide levels. Subsequent longitudinal behaviour was linked to baseline FEV(1) levels, which were lowest in patients with improvement and lower in association with decline than with stability. However, longitudinal behaviour did not differ between groups 1, 2 and 3, either before or after adjustment for baseline FEV(1) levels. Infection by Pseudomonas aeruginosa occurs in bronchiectasis patients with more severe impairment of pulmonary function but does not influence rate of decline in pulmonary function either before or after adjustment for baseline disease severity. Thus, Pseudomonas aeruginosa is a marker of bronchiectasis severity but is not linked to an accelerated decline in pulmonary function.
支气管扩张症患者易感染铜绿假单胞菌。感染与疾病严重程度增加、气流阻塞加重及生活质量下降相关。目前尚不清楚铜绿假单胞菌感染是疾病严重程度的标志物还是导致疾病进展的因素。根据铜绿假单胞菌的分离情况，将连续的非囊性纤维化成年支气管扩张症门诊患者（n = 163），这些患者有多次痰培养及随访肺功能测试结果，分为“从未感染”组（第1组；n = 67）、“间歇性分离”组（第2组；n = 82）和“慢性感染”组（第3组；n = 14）。根据就诊后≥2年时一秒用力呼气容积（FEV(1)）预测值百分比的变化，将纵向行为特征为“改善”（上升≥10%）、“下降”（下降≥10%）或“稳定”。研究了基线肺功能测试和纵向行为与假单胞菌状态的关系。各组在年龄、性别、吸烟习惯或随访时间方面无差异。第1组的基线FEV(1)水平最高（均值±标准差：77.4±24.3），第2组（67.3±25.7）高于第3组（55.2±18.5）。基线FEV(1)/用力肺活量比值和肺一氧化碳弥散量水平也呈现相同的显著趋势。随后的纵向行为与基线FEV(1)水平相关，改善患者的基线FEV(1)水平最低，下降患者的基线FEV(1)水平低于稳定患者。然而，在对基线FEV(1)水平进行调整前后，第1、2和3组之间的纵向行为并无差异。铜绿假单胞菌感染发生在肺功能损害更严重的支气管扩张症患者中，但在对基线疾病严重程度进行调整前后，均不影响肺功能下降速率。因此，铜绿假单胞菌是支气管扩张症严重程度的标志物，但与肺功能加速下降无关。
