Institute of Medical Microbiology and Hygiene, Universitätsklinikum Tübingen, Tübingen, Germany.
FEMS Microbiol Rev. 2011 Jan;35(1):124-46. doi: 10.1111/j.1574-6976.2010.00237.x.
Cystic fibrosis (CF), the most common autosomal recessive disorder in Caucasians, and chronic obstructive pulmonary disease (COPD), a disease of adults, are characterized by chronic lung inflammation, airflow obstruction and extensive tissue remodelling, which have a major impact on patients' morbidity and mortality. Airway inflammation is stimulated in CF by chronic bacterial infections and in COPD by environmental stimuli, particularly from smoking. Pseudomonas aeruginosa is the major bacterial pathogen in CF, while in COPD, Haemophilus influenzae is most frequently observed. Molecular studies indicate that during chronic pulmonary infection, P. aeruginosa clones genotypically and phenotypically adapt to the CF niche, resulting in a highly diverse bacterial community that is difficult to eradicate therapeutically. Pseudomonas aeruginosa clones from COPD patients remain within the airways only for limited time periods, do not adapt and are easily eradicated. However, in a subgroup of severely ill COPD patients, P. aeruginosa clones similar to those in CF persist. In this review, we will discuss the pathophysiology of lung disease in CF and COPD, the complex genotypic and phenotypic adaptation processes of the opportunistic bacterial pathogens and novel treatment options.
囊性纤维化 (CF) 是白种人中最常见的常染色体隐性遗传病，慢性阻塞性肺疾病 (COPD) 是一种成人疾病，其特征为慢性肺炎症、气流阻塞和广泛的组织重塑，这对患者的发病率和死亡率有重大影响。CF 中的气道炎症是由慢性细菌感染引起的，COPD 中的气道炎症是由环境刺激物引起的，特别是吸烟。铜绿假单胞菌是 CF 的主要细菌病原体，而流感嗜血杆菌在 COPD 中最常见。分子研究表明，在慢性肺部感染过程中，铜绿假单胞菌克隆在基因和表型上适应 CF 生态位，导致形成高度多样化的细菌群落，难以进行治疗性根除。COPD 患者的铜绿假单胞菌克隆仅在气道中存在有限的时间，不会适应，并且容易被根除。然而，在一组患有严重 COPD 的患者中，与 CF 中相似的铜绿假单胞菌克隆持续存在。在这篇综述中，我们将讨论 CF 和 COPD 中肺部疾病的病理生理学，机会性细菌病原体的复杂基因和表型适应过程，以及新的治疗选择。
