Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
Core Facility Molecular Biology, Center for Medical Research, Medical University of Graz, Graz, Austria.
Pediatr Res. 2021 Jul;90(1):66-73. doi: 10.1038/s41390-020-01222-7. Epub 2020 Nov 6.
Patients following repair of an esophageal atresia (EA) or tracheoesophageal fistula (TEF) carry an increased risk of long-term cardiopulmonary malaise. The role of the airway microbiome in EA/TEF patients remains unclear.
All EA/TEF patients treated between 1980 and 2010 were invited to a prospective clinical examination, spirometry, and spiroergometry. The airway microbiome was determined from deep induced sputum by 16 S rRNA gene sequencing. The results were compared to a healthy age- and sex-matched control group.
Nineteen EA/TEF patients with a mean age of 24.7 ± 7 years and 19 age- and sex-matched controls were included. EA/TEF patients showed a significantly lower muscle mass, lower maximum vital capacity (VC), and higher rates of restrictive ventilation disorders. Spiroergometry revealed a significantly lower relative performance capacity and lower peak VO in EA/TEF patients. Alpha- and beta-diversity of the airway microbiome did not differ significantly between the two groups. Linear discriminant effect size analysis revealed significantly enriched species of Prevotella_uncultured, Streptococcus_anginosus, Prevotella_7_Prevotella_enoeca, and Mogibacterium_timidum.
EA/TEF patients frequently suffer from restrictive ventilation disorders and impaired cardiopulmonary function associated with minor alterations of the airway microbiome. Long-term examinations of EA/TEF patients seem to be necessary in order to detect impaired cardiopulmonary function.
The key messages of the present study are a significantly decreased VC and exercise performance, as well as airway microbiome differences in EA/TEF patients. This study is the first to present parameters of lung function and exercise performance in combination with airway microbiome analysis with a mean follow-up of 24 years in EA/TEF patients. Prospective, long-term studies are needed to unravel possible interactions between alterations of the airway microbiome and impaired pulmonary function in EA/TEF patients.
食管闭锁（EA）或气管食管瘘（TEF）修复后的患者存在长期心肺不适的风险增加。气道微生物组在 EA/TEF 患者中的作用尚不清楚。
所有 1980 年至 2010 年间接受治疗的 EA/TEF 患者均被邀请参加前瞻性临床检查、肺活量测定和运动肺功能测定。通过 16S rRNA 基因测序从深部诱导痰中确定气道微生物组。结果与年龄和性别匹配的健康对照组进行比较。
19 例 EA/TEF 患者，平均年龄 24.7±7 岁，19 例年龄和性别匹配的对照组纳入研究。EA/TEF 患者的肌肉质量明显较低，最大肺活量（VC）较低，限制性通气障碍的发生率较高。运动肺功能测定显示 EA/TEF 患者的相对运动能力和峰值 VO 明显较低。两组之间气道微生物组的α和β多样性无显著差异。线性判别效应量分析显示，普雷沃氏菌未培养、酿脓链球菌、普雷沃氏菌 7_普雷沃氏菌肠杆菌和莫格杆菌的丰度显著增加。
EA/TEF 患者常患有限制性通气障碍和心肺功能受损，与气道微生物组的轻微改变有关。为了检测心肺功能受损，对 EA/TEF 患者进行长期检查似乎是必要的。
本研究的主要发现是 EA/TEF 患者的 VC 和运动表现显著降低，以及气道微生物组存在差异。这是第一项在 EA/TEF 患者中进行的，平均随访 24 年，同时进行肺功能和运动表现参数以及气道微生物组分析的研究。需要前瞻性、长期研究来揭示 EA/TEF 患者气道微生物组改变与肺功能受损之间可能的相互作用。
