1 Division of Gastroenterology, Department of Medicine.
2 Division of Infectious Diseases, Department of Medicine.
Am J Respir Crit Care Med. 2018 Mar 1;197(5):621-631. doi: 10.1164/rccm.201702-0441OC.
Cigarette smoking is associated with increased risk of acute respiratory distress syndrome (ARDS) in patients after severe trauma; however, the mechanisms underlying this association are unknown.
To determine whether cigarette smoking contributes to ARDS development after trauma by altering community composition of the lung microbiota.
We studied the lung microbiota of mechanically ventilated patients admitted to the ICU after severe blunt trauma. To do so, we used 16S ribosomal RNA gene amplicon sequencing of endotracheal aspirate samples obtained on ICU admission (n = 74) and at 48 hours after admission (n = 30). Cigarette smoke exposure (quantified using plasma cotinine), ARDS development, and other clinical parameters were correlated with lung microbiota composition.
Smoking status was significantly associated with lung bacterial community composition at ICU admission (P = 0.007 by permutational multivariate ANOVA [PERMANOVA]) and at 48 hours (P = 0.03 by PERMANOVA), as well as with significant enrichment of potential pathogens, including Streptococcus, Fusobacterium, Prevotella, Haemophilus, and Treponema. ARDS development was associated with lung community composition at 48 hours (P = 0.04 by PERMANOVA) and was characterized by relative enrichment of Enterobacteriaceae and of specific taxa enriched at baseline in smokers, including Prevotella and Fusobacterium.
After severe blunt trauma, a history of smoking is related to lung microbiota composition, both at the time of ICU admission and at 48 hours. ARDS development is also correlated with respiratory microbial community structure at 48 hours and with taxa that are relatively enriched in smokers at ICU admission. The data derived from this pilot study suggest that smoking-related changes in the lung microbiota could be related to ARDS development after severe trauma.
吸烟与严重创伤后急性呼吸窘迫综合征（ARDS）的发生风险增加有关；然而，其相关机制尚不清楚。
通过改变肺部微生物群落组成，确定吸烟是否会导致创伤后 ARDS 的发生。
我们研究了入住 ICU 的严重钝器伤后机械通气患者的肺部微生物群。为此，我们使用了气管内吸出物样本的 16S 核糖体 RNA 基因扩增子测序，这些样本分别在 ICU 入院时（n=74）和入院后 48 小时（n=30）采集。通过检测血浆可替宁来量化吸烟暴露情况，将吸烟暴露情况、ARDS 发生情况和其他临床参数与肺部微生物群落组成相关联。
吸烟状态与 ICU 入院时（PERMANOVA 通过置换多元方差分析，P=0.007）和 48 小时时（P=0.03）肺部细菌群落组成显著相关，并且与潜在病原体（包括链球菌、梭杆菌属、普雷沃菌属、嗜血杆菌属和密螺旋体属）的显著富集相关。ARDS 的发生与 48 小时时的肺部群落组成相关（PERMANOVA，P=0.04），其特征是肠杆菌科的相对富集，以及吸烟者在基线时富集的特定分类群，包括普雷沃菌属和梭杆菌属。
在严重钝器伤后，吸烟史与 ICU 入院时和 48 小时时的肺部微生物群落组成有关。ARDS 的发生也与 48 小时时的呼吸微生物群落结构以及在 ICU 入院时相对富集的吸烟者相关分类群有关。这项初步研究的数据表明，吸烟引起的肺部微生物群变化可能与严重创伤后 ARDS 的发生有关。
