Impact of Burkholderia dolosa on lung function and survival in cystic fibrosis
Impact of Burkholderia dolosa on lung function and survival in cystic fibrosis
复制标题
DOI：
10.1164/rccm.200503-344oc
复制
发表时间：
2006-02-15
影响因子：
24.7
通讯作者：
Goldmann, D
中科院分区：
文献类型：
--
作者：
Kalish, LA;Waltz, DA;Goldmann, D
基本原理：囊性纤维化患者的洋葱伯克霍尔德菌复合菌慢性感染与肺功能加速下降和死亡率增加相关。最近鉴定的基因型VI，B的临床意义。目的：描述B的影响。方法：我们比较了慢性感染B的患者。B. dolosa（n = 31）与B.多噬菌体（n = 24）和年龄和性别匹配的无伯克霍尔德菌属物种的对照受试者（n = 58）。我们使用随机效应模型（假设分段线性趋势）分析肺功能下降率（%预测FEV 1）。分析了从首次伯克霍尔德菌阳性培养（参考日期）前5年（中位数，4.8）至2.5年（中位数，1.5）的所有可用FEV 1测量值。使用Kaplan-Meier方法和比例风险模型比较生存率。测量和主要结果：基线FEV 1和下降率在队列中相似。在B患者中，参考日期后FEV 1下降加速。忧郁症（治疗前-2.3个百分点/年，治疗后-7.1个百分点，p = 0.002），但在B中没有变化。多囊动物和对照患者（分别为术后-2.3 vs. -0.8，p = 0.38和术前-2.1 vs. -0.5，p = 0.20）。B在参考日期18个月内死亡的概率分别为13、7和3%。dolosa，B.多噬菌体和对照患者（B.痛症组与对照组的风险比，10.8; 95%置信区间，1.3-92.8; p = 0.03）。结论：B。囊性纤维化中的多洛沙慢性感染与肺功能的加速丧失和存活率降低有关。
Rationale: Chronic infection with Burkholderia cepacia complex bacteria in cystic fibrosis is associated with accelerated decline in pulmonary function and increased mortality. Clinical implications of the recently characterized genomovar VI, B. dolosa, are unknown.Objectives: Characterization of impact of B. dolosa on pulmonary function and mortality in cystic fibrosis.Methods: We compared patients chronically infected with B. dolosa (n = 31) with unmatched patients with B. multivorans (n = 24) and with age- and sex-matched control subjects without Burkholderia species (n = 58). We analyzed rates of pulmonary function decline (% predicted FEV1) using a random effects model assuming segmented linear trends. All available FEV1 measurements from 5 yr (median, 4.8) before until 2.5 yr (median, 1.5) after the first positive culture for Burkholderia (reference date) were analyzed. Survival was compared using the Kaplan-Meier method and proportional hazards model.Measurements and Main Results: Baseline FEV1 and rate of decline were similar in the cohorts. Decline in FEV1 after the reference date accelerated in patients with B. dolosa (-2.3 percentage points/yr pre vs. -7.1 post, p = 0.002), but was unchanged in the B. multivorans and control patients (-2.3 vs. -0.8 post, p = 0.38, and -2.1 pre vs. -0.5 post, p = 0.20, respectively). The probability of dying within 18 mo of the reference date was 13, 7, and 3% for B. dolosa, B. multivorans, and control patients, respectively (B. dolosa vs. control hazard ratio, 10.8; 95% confidence interval, 1.3-92.8; p = 0.03).Conclusion: B. dolosa chronic infection in cystic fibrosis is associated with accelerated loss of lung function and decreased survival.