A novel microbiota stratification system predicts future exacerbations in bronchiectasis.
A novel microbiota stratification system predicts future exacerbations in bronchiectasis.
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DOI：
10.1513/annalsats.201310-335oc
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发表时间：
2014-05-01
影响因子：
8.3
通讯作者：
Serisier, David J
中科院分区：
文献类型：
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作者：
Rogers, Geraint B;Zain, Nur Masirah M;Serisier, David J
理由：尽管气道微生物群组成与非囊性纤维化支气管扩张症的临床测量相关，但这些数据不太可能在个体患者水平上提供有用的预后信息。一个能够将微生物群数据应用于临床的系统将代表重大的转化进步。 目的：本研究旨在确定与标准诊断相比，根据主要微生物群分类群对患者进行分层是否可以提供更好的临床洞察力。 方法：通过培养、定量 PCR 以及在 96 个样本中通过核糖体基因焦磷酸测序，评估 107 名成年患者的诱导痰中细菌呼吸道病原体的存在。对其中 42 名患者的样本进行了前瞻性分析。微生物学数据与同时的临床测量和随后的结果相关。测量和主要结果：微生物群分析定义了三组：铜绿假单胞菌为主（n = 26），流感嗜血杆菌为主（n = 34）和其他类群为主（n = 36）。铜绿假单胞菌和流感嗜血杆菌为主的社区患者的肺功能明显较差，血清 C 反应蛋白 (CRP) 水平较高，痰液中 IL-8 和 IL-1β 水平较高。铜绿假单胞菌占主导地位，其次是韦荣球菌属物种，是未来恶化频率的最佳预测因子，以流感嗜血杆菌为主的群落的发作次数明显较少。无论分析策略如何，铜绿假单胞菌的检测与肺功能不良和恶化频率相关。定量 PCR 显示流感嗜血杆菌水平与痰液 IL-8、IL-1β 和血清 CRP 之间存在显着相关性。属丰富度与 24 小时痰液重量、年龄、血清 CRP、痰液 IL-1β 和 IL-8 呈负相关。 结论：基于主要细菌分类群对非囊性纤维化支气管扩张患者进行分层比传统培养或基于定量 PCR 的分析更具临床信息。现在需要进一步调查来评估这些关联的机制基础。
RATIONALE: Although airway microbiota composition correlates with clinical measures in non-cystic fibrosis bronchiectasis, these data are unlikely to provide useful prognostic information at the individual patient level. A system enabling microbiota data to be applied clinically would represent a substantial translational advance.OBJECTIVES: This study aims to determine whether stratification of patients according to the predominant microbiota taxon can provide improved clinical insight compared with standard diagnostics.METHODS: The presence of bacterial respiratory pathogens was assessed in induced sputum from 107 adult patients by culture, quantitative PCR, and, in 96 samples, by ribosomal gene pyrosequencing. Prospective analysis was performed on samples from 42 of these patients. Microbiological data were correlated with concurrent clinical measures and subsequent outcomes.MEASUREMENTS AND MAIN RESULTS: Microbiota analysis defined three groups: Pseudomonas aeruginosa dominated (n = 26), Haemophilus influenzae dominated (n = 34), and other taxa dominated (n = 36). Patients with P. aeruginosa- and H. influenzae-dominated communities had significantly worse lung function, higher serum levels of C-reactive protein (CRP), and higher sputum levels of IL-8 and IL-1beta. Predominance of P. aeruginosa, followed by Veillonella species, was the best predictor of future exacerbation frequency, with H. influenzae-dominated communities having significantly fewer episodes. Detection of P. aeruginosa was associated with poor lung function and exacerbation frequency, irrespective of analytical strategy. Quantitative PCR revealed significant correlations between H. influenzae levels and sputum IL-8, IL-1beta, and serum CRP. Genus richness was negatively correlated with 24-hour sputum weight, age, serum CRP, sputum IL-1beta, and IL-8.CONCLUSIONS: Stratification of patients with non-cystic fibrosis bronchiectasis on the basis of predominant bacterial taxa is more clinically informative than either conventional culture or quantitative PCR-based analysis. Further investigation is now required to assess the mechanistic basis of these associations.