诱导痰微生态对住院慢性阻塞性肺疾病急性加重患者1年内死亡风险的研究  

Study on the induced sputum microbiome and 1-year mortality of hospitalized patients with AECOPD

作　　者：齐玉晶[1] 孙雪皎[2] 宾雁飞 李颖华[3] 王哲[1] 何志义[1] QI Yu-jing;SUN Xue-jiao;BIN Yan-fei;LI Ying-hua;WANG Zhe;HE Zhi-yi(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangxi Medical University,Narming 530021,China)

机构地区：[1]广西医科大学第一附属医院呼吸与危重症医学科,广西南宁530021 [2]柳州市人民医院呼吸与危重症医学科,广西柳州545006 [3]广西医科大学第二附属医院呼吸与危重症医学科,广西南宁530007

出　　处：《中国实用内科杂志》2020年第2期127-132,共6页Chinese Journal of Practical Internal Medicine

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S20180980);广西科技厅-广西科技重点研发计划项目(桂科AB17292044);中国宋庆龄基金会呼吸疾病临床研究公益基金2018年慢阻肺专项(2018MZFZY001)

摘　　要：目的探讨诱导痰微生态多样性与住院慢性阻塞性肺疾病急性加重(AECOPD)患者1年内死亡风险的关系。方法收集2016年12月至2017年12月在广西医科大学第一附属医院呼吸与危重症医学科住院的AECOPD患者共123例,使用16S rRNA方法检测患者入院第1天时的诱导痰微生态,出院后随访1年。使用Cox比例风险回归模型分析微生态Alpha多样性与1年内死亡风险的关系。结果死亡组的Shannon指数低于存活组,差异有统计学意义。Shannon指数每增加1个单位,死亡风险降低87.1%(95%CI:0.183~0.956,P=0.039)。在微生物门水平上,死亡组的拟杆菌门和放线菌门相对丰度低于存活组,蓝藻门相对丰度高于存活组,差异有统计学意义。在菌属水平上,死亡组的葡萄球菌属和假单胞菌属相对丰度高于存活组,韦氏菌属,普氏菌属-7和罗氏菌属相对丰度低于存活组,差异有统计学意义。结论诱导痰的微生物多样性与住院的AECOPD患者1年死亡风险相关,对AECOPD预后的预测有临床意义。Objective To understand the relationship between the variety of induced sputum microbiome and the 1-year mortality of acute exacerbations of chronic obstructive pulmonary disease(AECOPD). Methods The microbiome of induced sputum samples from 123 patients on the first day of hospitalization due to AECOPD was analyzed by sequencing of16 S rRNA gene. All subjects were followed for one year after discharge. Cox proportional-hazards regression models were used to investigate the associations of microbiome diversity with 1-year mortality. Results The Shannon index was significantly lower in the no-survival group compared to the survival group. The death risk decreased by 87.1% with the Shannon index increasing by one unit(95% CI:0.183-0.956,P=0.039). At phylum, the relative abundance of Bacteroidetes and Actinobacteria were lower in the no-survival group than those in the survival group. The Cyanobacteria was significantly higher in the no-survival group than that in the survival group. At genus level, the Staphylococcus and Pseudomonas were significantly higher in the no-survival group than that in the survival group. The Veillonella, Prevotella-7 and Rothia were lower in the no-survival group than that in the survival group. Conclusion The induced sputum microbiome is associated with 1-year mortality and may be a clinically significant factor for the assessment of prognosis of AECOPD.

关 键 词：慢性阻塞性肺疾病 急性加重期 诱导痰 微生态 病亡率 

分 类 号：R563.9[医药卫生—呼吸系统]