Zhang Xiao-Xian, He Jia-Hui, Pan Cui-Xia, He Zhen-Feng, Li Hui-Min, Lin Zhen-Hong, Zhang Xiao-Fen, Cen Lai-Jian, Zhang Ri-Lan, Shi Ming-Xin, Guan Wei-Jie
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Clin Transl Allergy. 2024 Jan;14(1):e12331. doi: 10.1002/clt2.12331.
Despite the high prevalence of co-existing bronchiectasis and asthma (asthma-bronchiectasis overlap syndrome [ABOS]), little is known regarding the dominant pathogens and clinical correlates.
To investigate the bacteria and viruses which differentially dominate in ABOS (including its subtypes) compared with bronchiectasis alone, and determine their relevance with bronchiectasis severity and exacerbations.
This was a prospective observational cohort study conducted between March 2017 and August 2023. We included 81 patients with ABOS and 107 patients with bronchiectasis alone. At steady-state baseline, patients underwent comprehensive assessments and sputum collection for bacterial culture and viral detection (quantitative polymerase-chain-reaction). Patients were followed-up to record exacerbation and spirometry.
Patients with ABOS had significantly higher symptom burden and exacerbation frequency than those with bronchiectasis alone. Despite similar pathogen spectrum, the rate of bacteria-virus co-detection increased less substantially at acute exacerbations (AE) onset than at steady-state compared with bronchiectasis alone. Pathogenic bacteria (particularly Pseudomonas aeruginosa) were detected fairly common (exceeding 50%) in ABOS and were associated with greater severity of bronchiectasis when stable and conferred greater exacerbation risks at follow-up. Viral but not bacterial compositions changed substantially at AE onset compared with clinical stability. Higher blood eosinophil count, moderate-to-severe bronchiectasis and non-atopy were associated with higher odds of bacterial, but not viral, detection (all p < 0.05).
Detection of bacteria or virus is associated with bronchiectasis severity or clinical outcomes in ABOS. This highlights the importance of integrating sputum microbial assessment for ascertaining the dominant pathophysiology (atopy vs. infection) and longitudinal trajectory prediction in ABOS.
尽管支气管扩张症和哮喘（哮喘-支气管扩张症重叠综合征[ABOS]）并存的情况很常见，但对于主要病原体和临床关联知之甚少。
研究与单纯支气管扩张症相比，在ABOS（包括其亚型）中差异占主导地位的细菌和病毒，并确定它们与支气管扩张症严重程度和急性加重的相关性。
这是一项在2017年3月至2023年8月期间进行的前瞻性观察队列研究。我们纳入了81例ABOS患者和107例单纯支气管扩张症患者。在稳定状态基线时，患者接受全面评估并采集痰液进行细菌培养和病毒检测（定量聚合酶链反应）。对患者进行随访以记录急性加重情况和肺功能测定。
ABOS患者的症状负担和急性加重频率显著高于单纯支气管扩张症患者。尽管病原体谱相似，但与单纯支气管扩张症相比，在急性加重（AE）发作时细菌-病毒共检测率的增加幅度小于稳定状态时。病原菌（尤其是铜绿假单胞菌）在ABOS中检测相当常见（超过50%），并且在稳定时与支气管扩张症的更严重程度相关，在随访时会带来更大的急性加重风险。与临床稳定相比，AE发作时病毒而非细菌组成发生了显著变化。较高的血嗜酸性粒细胞计数、中度至重度支气管扩张症和非特应性与细菌检测几率较高相关，但与病毒检测无关（所有p<0.05）。
在ABOS中，细菌或病毒检测与支气管扩张症严重程度或临床结局相关。这突出了整合痰液微生物评估对于确定主要病理生理学（特应性与感染）和预测ABOS纵向病程轨迹的重要性。
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