Hartmann Julia E, Albrich Werner C, Dmitrijeva Marija, Kahlert Christian R
Division of Infectious Diseases/Hospital Epidemiology, Kantonsspital St. Gallen, St.Gallen, Switzerland.
Department of Molecular Life Sciences, University of Zurich, Zurich, Switzerland.
Front Med (Lausanne). 2021 Mar 10;8:588584. doi: 10.3389/fmed.2021.588584. eCollection 2021.
Since its discovery, the respiratory microbiome has been implicated in the pathogenesis of multiple pulmonary diseases. Even though corticosteroid treatments are widely prescribed for pulmonary diseases, their effects on the respiratory microbiome are still poorly understood. This systematic review summarizes the current understanding of the effects of corticosteroids on the microbiome of the airways. How does treatment with corticosteroids impact the respiratory microbiome? According to the PRISMA guidelines, Embase, Medline, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched for all observational or randomized-controlled studies comparing the microbiome parameters of patients receiving corticosteroids to those of controls. The primary outcomes of interest were changes in the diversity, composition and total burden of the respiratory microbiome as assessed by culture-independent molecular methods. Out of 1,943 identified reports, five studies could be included: two on patients with asthma, two on patients with chronic obstructive pulmonary disease and one on patients with chronic rhinosinusitis. The studies were highly heterogeneous with regards to the methods used and the populations investigated. Microbiome diversity increased with corticosteroids at least transiently in three studies and decreased in one study. The effects of corticosteroids on the composition of the respiratory microbiome were significant but without a clear shared direction. A significant increase in microbial burden after corticosteroids was seen in one study. Data on the effect of corticosteroids on the respiratory microbiome are still limited, with considerable heterogeneity between studies. However, available data suggest that corticosteroid treatment may have significant effects on the composition and possibly the diversity of the respiratory microbiome. Further research is needed to better understand the influence of corticosteroids on the respiratory microbiome and thus better target its widespread therapeutic use.
自发现以来，呼吸道微生物群已被认为与多种肺部疾病的发病机制有关。尽管皮质类固醇治疗在肺部疾病中被广泛应用，但其对呼吸道微生物群的影响仍知之甚少。本系统综述总结了目前对皮质类固醇对气道微生物群影响的认识。皮质类固醇治疗如何影响呼吸道微生物群？根据PRISMA指南，系统检索了Embase、Medline和Cochrane对照试验中央注册库（CENTRAL）数据库，以查找所有比较接受皮质类固醇治疗患者与对照组微生物群参数的观察性或随机对照研究。感兴趣的主要结果是通过非培养分子方法评估的呼吸道微生物群的多样性、组成和总负担的变化。在1943篇已识别的报告中，有5项研究可以纳入：2项针对哮喘患者，2项针对慢性阻塞性肺疾病患者，1项针对慢性鼻-鼻窦炎患者。这些研究在所用方法和研究人群方面高度异质性。在三项研究中，微生物群多样性至少在短期内随着皮质类固醇治疗而增加，在一项研究中则减少。皮质类固醇对呼吸道微生物群组成的影响显著，但没有明确的共同方向。在一项研究中观察到皮质类固醇治疗后微生物负担显著增加。关于皮质类固醇对呼吸道微生物群影响的数据仍然有限，研究之间存在相当大的异质性。然而，现有数据表明，皮质类固醇治疗可能对呼吸道微生物群的组成以及可能的多样性有显著影响。需要进一步研究以更好地理解皮质类固醇对呼吸道微生物群的影响，从而更好地针对其广泛的治疗用途。
