Bronchiectasis
Bronchiectasis
复制标题
DOI：
10.1016/j.chest.2018.10.027
复制
发表时间：
2019-04-01
期刊：
影响因子：
9.6
通讯作者：
Tino, Gregory
中科院分区：
文献类型：
--
作者：
McShane, Pamela J.;Tino, Gregory
支气管扩张是一种重要的临床综合征，因为其患病率不断增加、医疗保健的巨大经济负担以及相关的发病率。直到最近，这种疾病还被认为是一种孤儿病，从治疗的角度来看基本上被忽视了，但该领域最近取得了许多进展。一些国家登记机构已经成立，提供研究支气管扩张患者的数据库。专家们发布了支气管扩张特异性恶化的共识定义，该定义将作为未来临床试验的统一定义。几项旨在降低恶化频率的吸入抗生素试验已经完成。研究人员研究了非培养技术，例如 16S 核糖体 RNA (rRNA) 和全基因组测序，以表征微生物特征。抗假单胞菌抗体的研究为了解宿主对慢性假单胞菌感染的不同反应提供了有趣的见解。在三项成功的试验证明大环内酯类药物可减少支气管扩张的恶化之后，人们对其他抗炎药物进行了研究，并且正在对一种新型抗炎药物进行试验。一项关于气道清除的相对有力的研究已经发表，这种疗法被普遍认为是有益的，但从未有过强有力的证据。为了在迄今为止支气管扩张方面取得的成功的基础上，研究人员必须对支气管扩张的表型制定更好的定义。在这方面，已经开发出临床工具来量化疾病严重程度并预测预后。关于支气管扩张患者不同临床表型的研究已发表。随着支气管扩张领域的不断进步，基于证据的治疗方法有望成为现实。
Bronchiectasis is an important clinical syndrome because of its increasing prevalence, substantial economic burden on health care, and associated morbidity. Until recently, the disease was considered an orphan and essentially neglected from a therapeutic standpoint, but many recent advances have been made in the field. Several national registries have formed to provide databases from which to study patients with bronchiectasis. Experts published a consensus definition of a bronchiectasis-specific exacerbation that will serve as a unified definition for future clinical trials. Several inhaled antibiotic trials aimed at reducing exacerbation frequency have been completed. Researchers have investigated nonculture techniques, such as 16S ribosomal RNA (rRNA) and whole genome sequencing, to characterize the microbiological characteristics. Studies of anti-Pseudomonas antibodies are providing interesting insight into varying host responses to chronic Pseudomonas infection. After three successful trials demonstrating that macrolides reduce exacerbations in bronchiectasis, other antiinflammatory agents have been investigated, and a trial of a novel antiinflammatory drug is ongoing. A relatively robust study has been published in airway clearance, a therapy that is accepted universally as beneficial but that has never been accompanied by strong evidence. To build on the successes with bronchiectasis thus far, investigators must develop better definitions of phenotypes of bronchiectasis. In this regard, clinical tools have been developed to quantify disease severity and predict prognosis. Studies of different clinical phenotypes of bronchiectasis in patients with bronchiectasis have been published. With continued advances in the field of bronchiectasis, there is hope that evidenced-based therapies will become available.