Chronic Bronchial Infection Is Associated with More Rapid Lung Function Decline in Chronic Obstructive Pulmonary Disease
Chronic Bronchial Infection Is Associated with More Rapid Lung Function Decline in Chronic Obstructive Pulmonary Disease
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DOI：
10.1513/annalsats.202108-974oc
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发表时间：
2022-11-01
影响因子：
8.3
通讯作者：
Agusti, Alvar
中科院分区：
文献类型：
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作者：
Angel Martinez-Garcia, Miguel;Faner, Rosa;Agusti, Alvar
理由：一些患有慢性阻塞性肺疾病 (COPD) 的患者随着时间的推移，肺功能（1 秒用力呼气量 [FEV1]）会加速下降。目的：探讨慢性支气管感染 (CBI)，特别是铜绿假单胞菌 (PA) 的分离，与 COPD 患者 FEV1 下降之间的关系。方法：对 201 名 COPD 患者进行前瞻性队列分析，每 3-6 个月进行一次随访，为期 84 个月。 CBI 被定义为 1 年内≥3 次相同病原微生物 (PPM) 的痰液培养阳性。根据任何 PPM 以及随访期间单次或多次 PA 分离，根据 CBI 的存在对患者进行分层。使用调整后的混合效应线性回归模型来研究 CBI 和 PA 隔离对 FEV1 随着时间的推移下降的独立影响。结果：在随访期间，43.3% 的患者从未分离出 PPM，其中 23.9% 的患者曾经分离过 PPM，32.8% 的参与者证实任何 PPM 引起的 CBI。整个队列的 FEV1 下降为 33.7（95% 置信区间 [CI]，21.4-46.1）ml/年。在任何 PPM 的 CBI 患者中（57.1 [95% CI, 28.5-79.3] ml/年）和 PA 至少分离一次的患者（48.5 [95% CI, 27.3-88.2] ml/年），这一比例显着增加。多变量分析表明，任何 PPM 均存在 CBI，以及至少一种 PA 隔离，是与基线 FEV1 调整后 FEV1 更快下降、支气管扩张、体重指数、年龄、病情加重、吸烟状况、症状、基线治疗和合并症相关的独立因素。结论：任何 PPM 引起的 CBI 以及一种或多种 PA 隔离与 COPD 患者的 FEV1 下降独立相关。
Rationale: Some patients with chronic obstructive pulmonary disease ( COPD) suffer accelerated lung function (forced expiratory volume in 1 second [FEV1]) decline over time. Objectives: To investigate the relationship between chronic bronchial infection (CBI) and, in particular, the isolation of Pseudomonas aeruginosa (PA), and FEV1 decline in COPD. Methods: Post-hoc analysis of a prospective cohort of 201 patients with COPD followed up every 3-6 months for 84 months. CBI was defined as >= 3 sputum positive cultures of the same pathogenic micro-organism (PPM) over 1 year. Patients were stratified according to the presence of CBI by any PPM, as well by a single or multiple isolation of PA during follow-up. An adjusted mixed-effects linear regression model was used to investigate the independent effects of CBI and PA isolation on FEV1 decline over time. Results: During follow-up, PPMs were never isolated in 43.3% of patients, in 23.9% of them PPMs were isolated once, and CBI by any PPM was confirmed in 32.8% of participants. FEV1 decline in the entire cohort was 33.7 (95% confidence interval [CI], 21.4-46.1) ml/year. This was significantly increased in patients with CBI by any PPM (57.1 [95% CI, 28.5-79.3] ml/year) and in those in whom PA was isolated at least once (48.5 [95% CI, 27.3-88.2] ml/year). Multivariable analysis showed that the presence of both CBI by any PPM, and at least one PA isolation, were independent factors associated with faster FEV1 decline adjusted by baseline FEV1, presence of bronchiectasis, body mass index, age, exacerbations, smoking status, symptoms, baseline treatment, and comorbidities. Conclusions: The presence of CBI by any PPM, and one or more PA isolation, were independently associated with FEV1 decline in patients with COPD.