支气管扩张
医学
恶化
微生物群
内科学
痰
星团(航天器)
免疫学
病理
肺结核
生物信息学
肺
生物
计算机科学
程序设计语言
作者
Hayoung Choi,Soorack Ryu,Holly R. Keir,Yan Hui Giam,Alison Dicker,Lídia Perea,Hollian Richardson,Jeffrey Huang,Erin Cant,Francesco Blasi,Jennifer S. Pollock,Michal Shteinberg,Simon Finch,Stefano Aliberti,Oriol Sibila,Amelia Shoemark,James D. Chalmers
标识
DOI:10.1164/rccm.202303-0499oc
摘要
Rationale: Although inflammation and infection are key disease drivers in bronchiectasis, few studies have integrated host inflammatory and microbiome data to guide precision medicine. Objectives: To identify clusters among bronchiectasis patients based on inflammatory markers and assess the association between inflammatory endotypes, microbiome characteristics, and exacerbation risk. Methods: Stable bronchiectasis patients were enrolled at three European centers and cluster analysis was used to stratify the patients according to the levels of 33 sputum and serum inflammatory markers. Clusters were compared in terms of microbiome composition (16S rRNA sequencing) and exacerbation risk over 12 months follow-up. Measurements and Main Results: 199 patients were enrolled (109 [54.8%] female, median age 69 years). Four clusters of patients were defined according to their inflammatory profiles: cluster 1 (milder neutrophilic inflammation), cluster 2 (mixed-neutrophilic and type 2), cluster 3 (most severe neutrophilic), and cluster 4 (mixed-epithelial and type 2). Lower microbiome diversity was associated with more severe inflammatory clusters (P<0.001), and beta-diversity analysis demonstrated distinct microbiome profiles associated with each inflammatory cluster (P=0.001). Proteobacteria and Pseudomonas at phylum and genus levels, respectively, were more enriched in clusters 2 and 3 than in clusters 1 and 4. Furthermore, patients in clusters 2 (rate ratio [RR] 1.49, 95% CI 1.16–1.92) and 3 (RR 1.61, 95% CI 1.12–2.32) were at higher risk of exacerbation over 12 months follow-up compared to cluster 1 even after adjustment for prior exacerbation history. Conclusion: Bronchiectasis inflammatory endotypes are associated with distinct microbiome profiles and future exacerbation risk.
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