细菌和病毒在 COPD-支气管扩张症相关性中的作用：一项前瞻性队列研究。
The roles of bacteria and viruses in COPD-Bronchiectasis association: A prospective cohort study.
机构信息
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Geriatrics, National Key Clinical Specialty, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.
出版信息
Respir Med. 2024 Sep;231:107692. doi: 10.1016/j.rmed.2024.107692. Epub 2024 Jun 7.
BACKGROUND
Exacerbations are implicated in bronchiectasis and COPD, which frequently co-exist [COPD-Bronchiectasis association (CBA)]. We aimed to determine the bacterial and viral spectrum at stable-state and exacerbation onset of CBA, and their association with exacerbations and clinical outcomes of CBA as compared with bronchiectasis.
METHODS
We prospectively collected spontaneous sputum from adults with CBA, bronchiectasis with (BO) and without airflow obstruction (BNO) for bacterial culture and viral detection at stable-state and exacerbations.
RESULTS
We enrolled 76 patients with CBA, 58 with BO, and 138 with BNO (711 stable and 207 exacerbation visits). Bacterial detection rate increased from BNO, CBA to BO at steady-state (P = 0.02), but not at AE onset (P = 0.91). No significant differences in viral detection rate were found among BNO, CBA and BO. Compared with steady-state, viral isolations occurred more frequently at exacerbation in BNO (15.8 % vs 32.1 %, P = 0.001) and CBA (19.5 % vs 30.6 %, P = 0.036) only. In CBA, isolation of viruses, human metapneumovirus and bacteria plus viruses was associated with exacerbation. Repeated detection of Pseudomonas aeruginosa (PA) correlated with higher modified Reiff score (P = 0.032) in CBA but not in BO (P = 0.178). Repeated detection of PA yielded a shorter time to the first exacerbation in CBA [median: 4.3 vs 11.1 months, P = 0.006] but not in BO (median: 8.4 vs 7.6 months, P = 0.47).
CONCLUSIONS
Isolation of any viruses, human metapneumovirus and bacterialplus viruses was associated with CBA exacerbations. Repeated detection of PA confers greater impact of future exacerbations on CBA than on BO.
背景
加重期与支气管扩张症和 COPD 有关，这两种疾病经常同时存在[COPD-支气管扩张症关联（CBA）]。我们旨在确定 CBA 稳定期和加重期的细菌和病毒谱，以及它们与加重期和 CBA 的临床结果的关系，与支气管扩张症进行比较。
方法
我们前瞻性地收集了 CBA、有（BO）和无气流阻塞（BNO）的支气管扩张症成年人的自发痰液，用于细菌培养和病毒检测，分别在稳定期和加重期进行。
结果
我们共纳入 76 例 CBA 患者、58 例 BO 患者和 138 例 BNO 患者（711 例稳定期和 207 例加重期就诊）。在稳定期，细菌检出率从 BNO、CBA 增加到 BO（P=0.02），但在加重期起始时无差异（P=0.91）。在 BNO、CBA 和 BO 中，病毒检出率无显著差异。与稳定期相比，只有在 BNO（15.8%对 32.1%，P=0.001）和 CBA（19.5%对 30.6%，P=0.036）中，病毒分离在加重期更常见。在 CBA 中，病毒、人类偏肺病毒和细菌加病毒的分离与加重期有关。反复检测铜绿假单胞菌（PA）与 CBA 中改良 Reiff 评分较高相关（P=0.032），但与 BO 无关（P=0.178）。反复检测 PA 可使 CBA 患者首次加重的时间更短[中位数：4.3 对 11.1 个月，P=0.006]，而 BO 患者无差异[中位数：8.4 对 7.6 个月，P=0.47]。
结论
任何病毒、人类偏肺病毒和细菌加病毒的分离都与 CBA 加重期有关。反复检测 PA 对 CBA 的未来加重影响大于 BO。
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