State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Guangdong General Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.
Arch Bronconeumol (Engl Ed). 2020 Oct;56(10):621-629. doi: 10.1016/j.arbr.2019.12.014. Epub 2020 Oct 1.
Exacerbations are crucial events during bronchiectasis progression.
To explore the associations between bacterial, viral, and bacterial plus viral isolations and bronchiectasis exacerbations.
In this prospective study, we enrolled 108 patients who were followed up every 3-6 months and at onset of exacerbations between March 2017 and November 2018. Spontaneous sputum was split for detection of bacteria (routine culture) and viruses (quantitative polymerase chain reaction). Symptoms and lung function were assessed during exacerbations.
The median exacerbation rate was 2.0 (interquartile range: 1.0-2.5) per patient-year. At any visit, viral isolations (V+) occurred more frequently during onset of exacerbations [odds ratio (OR): 3.28, 95% confidence interval (95%CI): 1.76-6.12], as did isolation of new bacteria (NB+) (OR: 2.52, 95%CI: 1.35-4.71) and bacterial plus viral isolations (OR: 2.24, 95%CI: 1.11-4.55). Whilst coryza appeared more common in exacerbations with V+ than in exacerbations with no pathogen isolations and those with NB+, lower airway symptoms were more severe in exacerbations with NB+ ( < .05). Sputum interleukin-1β levels were higher in exacerbations with NB+ than in exacerbations with no pathogen isolations and those with V+ (both < .05). Significantly more coryza symptoms correlated with bacterial plus viral isolations at exacerbations ( = .019). Compared with V+ alone, bacterial with and without viral isolations tended to yield more severe lower airway symptoms, but not sputum cytokine levels at exacerbations.
Viral isolations, isolation of new bacteria and bacterial plus viral isolation are associated with bronchiectasis exacerbations. Symptoms at exacerbations might inform clinicians the possible culprit pathogens.
加重是支气管扩张症进展过程中的关键事件。
探讨细菌、病毒和细菌加病毒分离物与支气管扩张症加重之间的关联。
在这项前瞻性研究中，我们招募了 108 名患者，他们在 2017 年 3 月至 2018 年 11 月期间每 3-6 个月进行一次随访，并在加重时进行随访。自发性痰液被分为细菌（常规培养）和病毒（定量聚合酶链反应）检测。在加重期间评估症状和肺功能。
中位加重率为每名患者每年 2.0 次（四分位距：1.0-2.5）。在任何一次就诊中，病毒分离物（V+）在加重开始时更频繁地发生[比值比（OR）：3.28，95%置信区间（95%CI）：1.76-6.12]，新细菌分离物（NB+）（OR：2.52，95%CI：1.35-4.71）和细菌加病毒分离物（OR：2.24，95%CI：1.11-4.55）也是如此。虽然 V+加重时的鼻塞比无病原体分离物和 NB+加重时更常见，但 NB+加重时的下呼吸道症状更严重（<.05）。NB+加重时的痰液白细胞介素-1β水平高于无病原体分离物和 V+加重时（均<.05）。NB+加重时鼻塞症状与细菌加病毒分离物的相关性更强（=0.019）。与 V+单独相比，细菌与病毒联合分离物和无病毒分离物倾向于导致更严重的下呼吸道症状，但加重时的痰液细胞因子水平没有差异。
病毒分离物、新细菌分离物和细菌加病毒分离物与支气管扩张症加重有关。加重时的症状可能提示临床医生可能的病原体。
