PDF(Pubmed)
Abstract：
Objective: Inhaled corticosteroids (ICS) are widely used in chronic obstructive pulmonary disease (COPD) patients as a treatment option. However, ICS may also increase the risk of pneumonia and alter the composition of airway microbiota. In clinical application, the overuse of ICS exists pervasively and may potentially lead to adverse effects. Whether the long-term use of ICS confers enough benefit to COPD patients to justify its use so far remains unknown. Therefore, this study employed a single-center retrospective cohort study to compare alterations in airway function and the sputum microbial community structure between COPD patients who had undergone either long-term or short-term treatment with ICS. Methods: Sixty stable COPD patients who had used ICS were recruited and classified into the long-term use group (more than 3 months) and short-term use group (less than 3 months). The demographic features and clinical information of the subjects were investigated and their sputum samples were collected and subjected to metagenomic next-generation sequencing (mNGS). Results: The study found that compared with short-term ICS use, long-term ICS use did not further improve the clinical airway function, decrease the number of acute exacerbations, or decrease hospital readmission. In terms of sputum microbiota, the long-term use of ICS significantly altered the beta diversity of the microbial community structure (p < 0.05) and the top three phyla differed between the two groups. At the genus level, long-term ICS induced higher relative abundances of Abiotrophia, Schaalia, Granulicatella, Mogibacterium, Sphingobium, and Paraeggerthella compared to short-term ICS use. Additionally, alpha diversity was positively associated with clinical airway indicators (pre-bronchodilatory FEV1 and pre-bronchodilatory FVC) in the long-term ICS group. The relative abundances of Rothia, Granulicatella, Schaalia, and Mogibacterium genera had positive correlations with the eosinophil % (of all white blood cells). Conclusion: This study reveals the effect of long-term and short-term ICS use on sputum microbiota among COPD patients and provides a reference for the appropriate application of clinical ICS treatment in COPD patients.
摘要：
目的:吸入糖皮质激素(ICS)作为一种治疗选择被广泛应用于慢性阻塞性肺疾病(COPD)患者。然而,ICS还可能增加肺炎的风险并改变气道微生物群的组成。在临床应用中,ICS的过度使用普遍存在,可能导致不良反应.到目前为止，长期使用ICS是否为COPD患者提供了足够的益处，以证明其使用的合理性仍然未知。因此,本研究采用单中心回顾性队列研究,比较长期或短期接受ICS治疗的COPD患者之间气道功能和痰微生物群落结构的改变.方法：纳入60例使用ICS的稳定期COPD患者，分为长期使用组（超过3个月）和短期使用组（少于3个月）。调查受试者的人口统计学特征和临床信息，收集他们的痰液样本并进行宏基因组下一代测序（mNGS）。结果：研究发现，与短期使用ICS相比，长期使用ICS并没有进一步改善临床气道功能，减少急性加重的次数，或减少再入院。就痰菌群而言，长期使用ICS显着改变了微生物群落结构的β多样性（p<0.05），两组之间的前三个门不同。在属一级，长期ICS诱导了更高的相对丰度的Abioprophia，Schaalia,肉芽肿,小杆菌属,鞘氨醇,和Paraeggerthella与短期ICS使用相比。此外,长期ICS组的α多样性与临床气道指标(支气管扩张前FEV1和支气管扩张前FVC)呈正相关.Rothia的相对丰富,肉芽肿,Schaalia,与嗜酸性粒细胞百分比（占所有白细胞的百分比）呈正相关。结论:本研究揭示了长期和短期使用ICS对COPD患者痰菌群的影响,为临床ICS治疗在COPD患者中的适当应用提供了参考。
