Royal Infirmary of Edinburgh, Department of Respiratory Medicine, Edinburgh, United Kingdom.
Am J Respir Crit Care Med. 2012 Oct 1;186(7):657-65. doi: 10.1164/rccm.201203-0487OC. Epub 2012 Jun 28.
The vicious cycle hypothesis of bronchiectasis argues that bacterial colonization leads to airway inflammation and progressive lung damage. The logical extension of this hypothesis is that acute or chronic antibiotic therapy should improve airway inflammation and clinical outcome. There are little data to support this hypothesis in patients with non-cystic fibrosis (CF) bronchiectasis.
To determine whether acute or chronic antibiotic therapy improves airway inflammation and clinical outcome in non-CF bronchiectasis.
The relationship between bacterial load and airway and systemic inflammation was investigated in 385 stable patients, 15 stable patients treated with intravenous antibiotics, and 34 patients with an exacerbation of bronchiectasis treated with intravenous antibiotics. Long-term antibiotic therapy was investigated using samples from a 12-month controlled trial of nebulized gentamicin.
In stable patients, there was a direct relationship between airway bacterial load and markers of airway inflammation (P < 0.0001 for all analyses). High bacterial loads were associated with higher serum intercellular adhesion molecule-1, E-selectin, and vascular cell adhesion molecule-1 (P < 0.05 above bacterial load ≥1 × 10(7) cfu/ml). In stable patients, there was a direct relationship between bacterial load and the risk of subsequent exacerbations (odds ratio, 1.20; 95% confidence interval, 1.11-1.29; P < 0.0001) and severe exacerbations (odds ratio, 1.11; 95% confidence interval, 1.01-1.21; P = 0.02). Short- and long-term antibiotic treatments were associated with reductions in bacterial load, airways, and systemic inflammation.
High airway bacterial loads in non-CF bronchiectasis are associated with airway and systemic inflammation and a greater risk of exacerbations. Short- and long-term antibiotic therapy reduce markers of airways and systemic inflammation.
支气管扩张症的恶性循环假说认为，细菌定植可导致气道炎症和进行性肺损伤。该假说的逻辑延伸是，急性或慢性抗生素治疗应改善气道炎症和临床结局。然而，非囊性纤维化（CF）支气管扩张症患者的相关数据很少。
确定急性或慢性抗生素治疗是否能改善非 CF 支气管扩张症患者的气道炎症和临床结局。
研究了 385 例稳定期患者、15 例接受静脉抗生素治疗的稳定期患者和 34 例支气管扩张症加重期接受静脉抗生素治疗的患者的细菌负荷与气道和全身炎症之间的关系。使用为期 12 个月的雾化庆大霉素对照试验的样本研究了长期抗生素治疗。
在稳定期患者中，气道细菌负荷与气道炎症标志物之间存在直接关系（所有分析均 P<0.0001）。高细菌负荷与血清细胞间黏附分子-1、E-选择素和血管细胞黏附分子-1升高相关（细菌负荷≥1×10(7) cfu/ml 时 P<0.05）。在稳定期患者中，细菌负荷与随后发生加重的风险（比值比，1.20；95%置信区间，1.11-1.29；P<0.0001）和严重加重的风险（比值比，1.11；95%置信区间，1.01-1.21；P=0.02）之间存在直接关系。短期和长期抗生素治疗与细菌负荷、气道和全身炎症的减少相关。
非 CF 支气管扩张症患者的气道高细菌负荷与气道和全身炎症以及加重的风险增加有关。短期和长期抗生素治疗可降低气道和全身炎症标志物。
