气流阻塞是支气管扩张疾病严重程度和预后的标志。肺部微生物群、气道炎症和固定气流阻塞（FAO）支气管扩张的结局之间的关系仍不清楚。本研究探讨了支气管扩张患者（无论是否接受FAO）的这些相互作用，并将其与诊断为慢性阻塞性肺病（COPD）的患者进行比较。这项在台湾进行的前瞻性观察性研究纳入了支气管扩张或COPD患者。为了分析肺部微生物组并评估炎症标志物，收集支气管肺泡灌洗液 (BAL) 样本进行 16S rRNA 基因测序。该研究队列由 181 名患者组成：86 名患有慢性阻塞性肺病，46 名患有支气管扩张，49 名患有支气管扩张和FAO，经肺活量测定证实。患有支气管扩张的患者，无论有或没有FAO，都具有相似的微生物组特征，其特征是α多样性减少和变形菌占主导地位。 ，与 COPD 患者明显不同，后者表现出更多的厚壁菌门、更大的多样性和更多的共生类群。此外，与不使用FAO的COPD和支气管扩张症相比，使用FAO的支气管扩张症表现出更严重的疾病和更高的病情恶化风险。研究发现，铜绿假单胞菌的存在与气道中性粒细胞炎症（例如白细胞介素 [IL]-1β、IL-8 和肿瘤坏死因子-α [TNF]-α）的增加以及支气管扩张严重程度的增加之间存在显着相关性。可能会导致病情加重的风险增加。此外，在患有FAO的支气管扩张患者中，根据吸烟史，采用ROSE（放射学、阻塞、症状和暴露）标准将个体分类为ROSE（ ）或ROSE（-）。该分类强调了 ROSE (-) 和 ROSE ( ) 患者之间临床特征、炎症特征和轻微微生物组差异的差异，表明FAO 组支气管扩张患者存在不同的内型。FAO 支气管扩张患者可能表现出两种不同的内型，如 ROSE 所定义的标准，其特征是疾病严重程度更高，并且肺部微生物组与慢性阻塞性肺病相比更类似于没有FAO的支气管扩张。铜绿假单胞菌定植与气道中性粒细胞炎症增加以及疾病严重程度之间的显着相关性强调了微生物模式的临床相关性。这一发现强化了这些模式在支气管扩张的进展和恶化中的潜在作用。© 2024。作者。

Airflow obstruction is a hallmark of disease severity and prognosis in bronchiectasis. The relationship between lung microbiota, airway inflammation, and outcomes in bronchiectasis with fixed airflow obstruction (FAO) remains unclear. This study explores these interactions in bronchiectasis patients, with and without FAO, and compares them to those diagnosed with chronic obstructive pulmonary disease (COPD).This prospective observational study in Taiwan enrolled patients with either bronchiectasis or COPD. To analyze the lung microbiome and assess inflammatory markers, bronchoalveolar lavage (BAL) samples were collected for 16S rRNA gene sequencing. The study cohort comprised 181 patients: 86 with COPD, 46 with bronchiectasis, and 49 with bronchiectasis and FAO, as confirmed by spirometry.Patients with bronchiectasis, with or without FAO, had similar microbiome profiles characterized by reduced alpha diversity and a predominance of Proteobacteria, distinctly different from COPD patients who exhibited more Firmicutes, greater diversity, and more commensal taxa. Furthermore, compared to COPD and bronchiectasis without FAO, bronchiectasis with FAO showed more severe disease and a higher risk of exacerbations. A significant correlation was found between the presence of Pseudomonas aeruginosa and increased airway neutrophilic inflammation such as Interleukin [IL]-1β, IL-8, and tumor necrosis factor-alpha [TNF]-α, as well as with higher bronchiectasis severity, which might contribute to an increased risk of exacerbations. Moreover, in bronchiectasis patients with FAO, the ROSE (Radiology, Obstruction, Symptoms, and Exposure) criteria were employed to classify individuals as either ROSE (+) or ROSE (-), based on smoking history. This classification highlighted differences in clinical features, inflammatory profiles, and slight microbiome variations between ROSE (-) and ROSE (+) patients, suggesting diverse endotypes within the bronchiectasis with FAO group.Bronchiectasis patients with FAO may exhibit two distinct endotypes, as defined by ROSE criteria, characterized by greater disease severity and a lung microbiome more similar to bronchiectasis without FAO than to COPD. The significant correlation between Pseudomonas aeruginosa colonization and increased airway neutrophilic inflammation, as well as disease severity, underscores the clinical relevance of microbial patterns. This finding reinforces the potential role of these patterns in the progression and exacerbations of bronchiectasis with FAO.© 2024. The Author(s).