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Abstract：
BACKGROUND: Airflow obstruction is a hallmark of disease severity and prognosis in bronchiectasis. The relationship between lung microbiota, airway inflammation, and outcomes in bronchiectasis with fixed airflow obstruction (FAO) remains unclear. This study explores these interactions in bronchiectasis patients, with and without FAO, and compares them to those diagnosed with chronic obstructive pulmonary disease (COPD).
METHODS: This prospective observational study in Taiwan enrolled patients with either bronchiectasis or COPD. To analyze the lung microbiome and assess inflammatory markers, bronchoalveolar lavage (BAL) samples were collected for 16S rRNA gene sequencing. The study cohort comprised 181 patients: 86 with COPD, 46 with bronchiectasis, and 49 with bronchiectasis and FAO, as confirmed by spirometry.
RESULTS: Patients with bronchiectasis, with or without FAO, had similar microbiome profiles characterized by reduced alpha diversity and a predominance of Proteobacteria, distinctly different from COPD patients who exhibited more Firmicutes, greater diversity, and more commensal taxa. Furthermore, compared to COPD and bronchiectasis without FAO, bronchiectasis with FAO showed more severe disease and a higher risk of exacerbations. A significant correlation was found between the presence of Pseudomonas aeruginosa and increased airway neutrophilic inflammation such as Interleukin [IL]-1β, IL-8, and tumor necrosis factor-alpha [TNF]-α, as well as with higher bronchiectasis severity, which might contribute to an increased risk of exacerbations. Moreover, in bronchiectasis patients with FAO, the ROSE (Radiology, Obstruction, Symptoms, and Exposure) criteria were employed to classify individuals as either ROSE (+) or ROSE (-), based on smoking history. This classification highlighted differences in clinical features, inflammatory profiles, and slight microbiome variations between ROSE (-) and ROSE (+) patients, suggesting diverse endotypes within the bronchiectasis with FAO group.
CONCLUSIONS: Bronchiectasis patients with FAO may exhibit two distinct endotypes, as defined by ROSE criteria, characterized by greater disease severity and a lung microbiome more similar to bronchiectasis without FAO than to COPD. The significant correlation between Pseudomonas aeruginosa colonization and increased airway neutrophilic inflammation, as well as disease severity, underscores the clinical relevance of microbial patterns. This finding reinforces the potential role of these patterns in the progression and exacerbations of bronchiectasis with FAO.
METHODS: This prospective observational study in Taiwan enrolled patients with either bronchiectasis or COPD. To analyze the lung microbiome and assess inflammatory markers, bronchoalveolar lavage (BAL) samples were collected for 16S rRNA gene sequencing. The study cohort comprised 181 patients: 86 with COPD, 46 with bronchiectasis, and 49 with bronchiectasis and FAO, as confirmed by spirometry.
RESULTS: Patients with bronchiectasis, with or without FAO, had similar microbiome profiles characterized by reduced alpha diversity and a predominance of Proteobacteria, distinctly different from COPD patients who exhibited more Firmicutes, greater diversity, and more commensal taxa. Furthermore, compared to COPD and bronchiectasis without FAO, bronchiectasis with FAO showed more severe disease and a higher risk of exacerbations. A significant correlation was found between the presence of Pseudomonas aeruginosa and increased airway neutrophilic inflammation such as Interleukin [IL]-1β, IL-8, and tumor necrosis factor-alpha [TNF]-α, as well as with higher bronchiectasis severity, which might contribute to an increased risk of exacerbations. Moreover, in bronchiectasis patients with FAO, the ROSE (Radiology, Obstruction, Symptoms, and Exposure) criteria were employed to classify individuals as either ROSE (+) or ROSE (-), based on smoking history. This classification highlighted differences in clinical features, inflammatory profiles, and slight microbiome variations between ROSE (-) and ROSE (+) patients, suggesting diverse endotypes within the bronchiectasis with FAO group.
CONCLUSIONS: Bronchiectasis patients with FAO may exhibit two distinct endotypes, as defined by ROSE criteria, characterized by greater disease severity and a lung microbiome more similar to bronchiectasis without FAO than to COPD. The significant correlation between Pseudomonas aeruginosa colonization and increased airway neutrophilic inflammation, as well as disease severity, underscores the clinical relevance of microbial patterns. This finding reinforces the potential role of these patterns in the progression and exacerbations of bronchiectasis with FAO.
摘要：
背景：气流阻塞是支气管扩张症疾病严重程度和预后的标志。肺微生物群之间的关系，气道炎症,固定气流阻塞的支气管扩张(FAO)的结局尚不清楚.这项研究探讨了支气管扩张患者的这些相互作用，有和没有粮农组织，并将其与被诊断为慢性阻塞性肺疾病（COPD）的患者进行比较。
方法：这项在台湾进行的前瞻性观察性研究纳入了支气管扩张或COPD患者。为了分析肺部微生物组并评估炎症标志物，收集支气管肺泡灌洗（BAL）样品进行16SrRNA基因测序。研究队列包括181名患者：86名患有COPD，46患有支气管扩张，49与支气管扩张和粮农组织，肺活量测定证实。
结果：支气管扩张患者，无论有没有粮农组织，具有相似的微生物组谱，其特征是α多样性降低和变形杆菌占优势，与表现出更多Firmicutes的COPD患者明显不同，更大的多样性，和更多的共生类群。此外，与没有粮农组织的COPD和支气管扩张相比，粮农组织的支气管扩张症显示出更严重的疾病和更高的恶化风险。发现铜绿假单胞菌的存在与气道中性粒细胞性炎症如白细胞介素[IL]-1β的增加之间存在显着相关性。IL-8和肿瘤坏死因子-α[TNF]-α，以及更高的支气管扩张严重程度，这可能会增加恶化的风险。此外，在粮农组织的支气管扩张患者中，罗斯(放射学，妨碍,症状,和暴露)标准被用来将个体分类为ROSE(+)或ROSE(-)，根据吸烟史。这种分类突出了临床特征的差异，炎症特征，ROSE(-)和ROSE(+)患者之间的微生物组轻微变化，提示与FAO组的支气管扩张中存在不同的内生型。
结论：患有FAO的支气管扩张症患者可能表现出两种不同的基因型，根据ROSE标准的定义，其特征是疾病严重程度更高，肺部微生物组与无FAO的支气管扩张比COPD更相似。铜绿假单胞菌定植与气道中性粒细胞性炎症增加显著相关,以及疾病的严重程度，强调了微生物模式的临床相关性。这一发现加强了这些模式在粮农组织支气管扩张的进展和恶化中的潜在作用。
方法：这项在台湾进行的前瞻性观察性研究纳入了支气管扩张或COPD患者。为了分析肺部微生物组并评估炎症标志物，收集支气管肺泡灌洗（BAL）样品进行16SrRNA基因测序。研究队列包括181名患者：86名患有COPD，46患有支气管扩张，49与支气管扩张和粮农组织，肺活量测定证实。
结果：支气管扩张患者，无论有没有粮农组织，具有相似的微生物组谱，其特征是α多样性降低和变形杆菌占优势，与表现出更多Firmicutes的COPD患者明显不同，更大的多样性，和更多的共生类群。此外，与没有粮农组织的COPD和支气管扩张相比，粮农组织的支气管扩张症显示出更严重的疾病和更高的恶化风险。发现铜绿假单胞菌的存在与气道中性粒细胞性炎症如白细胞介素[IL]-1β的增加之间存在显着相关性。IL-8和肿瘤坏死因子-α[TNF]-α，以及更高的支气管扩张严重程度，这可能会增加恶化的风险。此外，在粮农组织的支气管扩张患者中，罗斯(放射学，妨碍,症状,和暴露)标准被用来将个体分类为ROSE(+)或ROSE(-)，根据吸烟史。这种分类突出了临床特征的差异，炎症特征，ROSE(-)和ROSE(+)患者之间的微生物组轻微变化，提示与FAO组的支气管扩张中存在不同的内生型。
结论：患有FAO的支气管扩张症患者可能表现出两种不同的基因型，根据ROSE标准的定义，其特征是疾病严重程度更高，肺部微生物组与无FAO的支气管扩张比COPD更相似。铜绿假单胞菌定植与气道中性粒细胞性炎症增加显著相关,以及疾病的严重程度，强调了微生物模式的临床相关性。这一发现加强了这些模式在粮农组织支气管扩张的进展和恶化中的潜在作用。
