背景:支气管扩张(BE)传统上与中性粒细胞炎症有关,但嗜酸性粒细胞支气管扩张(EB)最近出现。有关患病率的数据,临床特征,缺乏疾病严重程度。本研究旨在评估EB的患病率,比较EB与非EB,评估BE(T2-highEB)中的2型(T2)高基因型与非T2-highEB,并确定EB预测因子。方法:我们进行了一项涉及153例BE患者的前瞻性研究。收集的数据包括临床,放射学,和微生物学发现。使用支气管扩张严重程度指数(BSI)评估BE严重程度,面对和电子面对得分,以及支气管扩张的病因和合并症指数(BACI)。EB被定义为血液嗜酸性粒细胞计数(BEC)≥300个细胞/μL,T2高EB为BEC≥300个细胞/μL,部分呼出气一氧化氮(FeNO)≥25ppb。结果:EB的患病率为27%,T2高EB的患病率为20%。EB患者表现出较差的肺功能和更严重的放射学特征,严重程度评分明显较高[BSI,面对,E-FACED,BACI(p<0.05)],和更高的中位数恶化率[4(2-5)与EB相比2(1-4)在非EB中,p=0.0002],与非EB患者相比。T2高EB患者表现出更高的严重程度评分[BSI,面对,E-FACED(p<0.05)],以及更差的肺功能参数[FEV1%,FVC%,FEF25-75%(p<0.05)]与非T2高EB患者相比。在我们的研究中,与非EB患者相比,EB患者的肺功能明显恶化,BE严重程度评分更高,恶化在这些差异中起着重要作用。我们发现BEC和疾病严重程度评分之间存在统计学上显著的正相关,比如BSI,面对,和mMRC,以及与肺功能的反比关系。EB存在的可能性与mMRC≥1相关(OR=2.53;95%CI,1.26-5.64),加重/年≥1(OR=1.27;95%CI,1.0-1.63),和慢性PA定植(OR=3.9;95%CI,1.08-15.8)。结论:EB是一种独特的内型。呼吸困难,恶化,PA定植可以预测EB,强调早期检测对改善结果的重要性。BEC可以作为诊断EB时考虑的疾病严重程度的有用生物标志物。
Background: Bronchiectasis (BE) has been traditionally associated with neutrophilic inflammation, but eosinophilic bronchiectasis (EB) has recently emerged. Data about prevalence, clinical features, and disease severity are lacking. This study aimed to assess the EB prevalence, compare EB with non-EB, evaluate the Type-2 (T2) high endotype in BE (T2-high EB) versus non-T2-high EB, and identify EB predictors. Methods: We conducted a prospective study involving 153 BE patients. The data collected included clinical, radiological, and microbiological findings. BE severity was assessed using the bronchiectasis severity index (BSI), FACED and E-FACED scores, and the bronchiectasis etiology and comorbidity index (BACI). EB was defined as a blood eosinophil count (BEC) ≥ 300 cells/μL, and T2-high EB as BEC ≥ 300 cells/μL with fractional exhaled nitric oxide (FeNO) ≥ 25 ppb. Results: Prevalence was 27% for EB and 20% for T2-high EB. EB patients exhibited poorer lung function and more severe radiologic features, with significantly higher severity scores [BSI, FACED, E-FACED, BACI (p < 0.05)], and a higher median exacerbation rate [4 (2-5) in EB vs. 2 (1-4) in non-EB, p = 0.0002], compared with non-EB patients. T2-high EB patients showed higher severity scores [BSI, FACED, E-FACED (p < 0.05)], as well as worse lung function parameters [FEV1%, FVC%, FEF 25-75% (p < 0.05)] compared with non-T2-high EB patients. In our study, patients with EB exhibited notably worsened lung function and higher BE severity scores compared with their non-EB counterparts, with
exacerbations playing a major role in these differences. We found statistically significant positive correlations between BEC and disease severity scores, such as BSI, FACED, and mMRC, as well as an inverse relationship with pulmonary function. The likelihood of EB being present was significantly higher in association with mMRC ≥ 1 (OR = 2.53; 95% CI, 1.26-5.64),
exacerbations/year ≥ 1 (OR = 1.27; 95% CI, 1.0-1.63), and chronic PA colonization (OR = 3.9; 95% CI, 1.08-15.8). Conclusions: EB is a distinct endotype. Dyspnea,
exacerbations, and PA colonization may be predictive of EB, emphasizing the importance of early detection for improved outcomes. BEC could serve as a useful biomarker of disease severity to consider when diagnosing EB.