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Clinical factors associated with composition of lung microbiota and important taxa predicting clinical prognosis in patients with severe community-acquired pneumonia

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Frontiers of Medicine 2022年第3期16卷 389-402页

作者： Sisi Du Xiaojing Wu Binbin Li Yimin Wang lianhan shang Xu Huang Yudi Xia Donghao Yu Naicong Lu Zhibo Liu Chunlei Wang Xinmeng Liu Zhujia Xiong Xiaohui Zou Binghuai Lu Yingmei Liu Qingyuan Zhan Bin Cao China-Japan Friendship Hospital National Clinical Research Center for Respiratory DiseasesNational Center for Respiratory MedicineClinical Center for Pulmonary InfectionsCapital Medical UniversityBeijing 100029China Institute of Respiratory Medicine Chinese Academy of Medical SciencesPeking Union Medical CollegeBeijing 100029China Department of Pulmonary and Critical Care Medicine Center for Respiratory DiseasesChina-Japan Friendship HospitalBeijing 100029China Beijing University of Chinese Medicine Beijing 100029China Beijing Luhe Hospital Beijing 101100China Tsinghua University–Peking University Joint Center for Life Sciences Beijing 100084China

Few studies have described the key features and prognostic roles of lung microbiota in patients with severe community-acquired pneumonia(SCAP).We prospectively enrolled consecutive SCAP patients admitted to ICU.Bronchoscopy was performed at bedside within 48 h of ICU admission,and 16S rRNA gene sequencing was applied to the collected bronchoalveolar lavage fluid.The primary outcome was clinical improvements defined as a decrease of 2 categories and above on a 7-category ordinal scale within 14 days following bronchoscopy.Sixty-seven patients were included.Multivariable permutational multivariate analysis of variance found that positive bacteria lab test results had the strongest independent association with lung microbiota(R2=0.033;P=0.018),followed by acute kidney injury(AKI;R2=0.032;P=0.011)and plasma MIP-1βlevel(R2=0.027;P=0.044).Random forest identified that the families Prevotellaceae,Moraxellaceae,and Staphylococcaceae were the biomarkers related to the positive bacteria lab test results.Multivariable Cox regression showed that the increase inα-diversity and the abundance of the families Prevotellaceae and Actinomycetaceae were associated with clinical improvements.The positive bacteria lab test results,AKI,and plasma MIP-1βlevel were associated with patients’lung microbiota composition on ICU admission.The families Prevotellaceae and Actinomycetaceae on admission predicted clinical improvements.

关键词： severe community-acquired pneumonia lung microbiota clinical improvements 7-category ordinal scale Prevotellaceae

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Use of angiotensin-converting enzyme inhibitors and angiotensin Ⅱ receptor blockers in context of COVID-19 outbreak:a retrospective analysis

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Frontiers of Medicine 2020年第5期14卷 601-612页

作者： Jiuyang Xu Chaolin Huang Guohui Fan Zhibo Liu lianhan shang Fei Zhou Yeming Wang Jiapei Yu Luning Yang Ke Xie Zhisheng Huang Lixue Huang Xiaoying Gu Hui Li Yi Zhang Yimin Wang Frederick G.Hayden Peter W.Horby Bin Cao Chen Wang Department of Basic Medical Sciences Tsinghua University School of MedicineBeijing 100084China Department of Infectious Diseases Jinyintan HospitalWuhan 430030China Department of Pulmonary and Critical Care Medicine Center of Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesChina-Japan Friendship HospitalBeijing 100029China Institute of Respiratory Medicine Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Institute of Clinical Medical Sciences China-Japan Friendship HospitalBeijing 100029China Beijing University of Chinese Medicine Beijing 100029China Department of Respiratory Medicine Capital Medical UniversityBeijing 100029China Graduate School of Peking Union Medical College Chinese Academy of Medical SciencesBeijing 100730China Department of Medicine University of Virginia School of MedicineCharlottesvilleVA 22904USA Centre for Tropical Medicine and Global Health University of OxfordOxford OX12JDUK Tsinghua University-Peking University Joint Center for Life Sciences Beijing 100084China Chinese Academy of Engineering Beijing 100088China

The possible effects of angiotensin-converting enzyme inhibitors(ACEIs)or angiotensin Ⅱ receptor blockers(ARBs)on COVID-19 disease severity have generated considerable debate.We performed a single-center,retrospective analysis of hospitalized adult COVID-19 patients in Wuhan,China,who had definite clinical outcome(dead or discharged)by February 15,2020.Patients on anti-hypertensive treatment with or without ACEI/ARB were compared on their clinical characteristics and outcomes.The medical records from 702 patients were screened.Among the 101 patients with a history of hypertension and taking at least one anti-hypertensive medication,40 patients were receiving ACEI/ARB as part of their regimen,and 61 patients were on antihypertensive medication other than ACEI/ARB.We observed no statistically significant differences in percentages of in-hospital mortality(28%vs.34%,P=0.46),ICU admission(20%vs.28%,P=0.37)or invasive mechanical ventilation(18%vs.26%,P=0.31)between patients with or without ACEI/ARB treatment.Further multivariable adjustment of age and gender did not provide evidence for a significant association between ACEI/ARB treatment and severe COVID-19 outcomes.Our findings confirm the lack of an association between chronic receipt of reninangiotensin system antagonists and severe outcomes of COVID-19.Patients should continue previous antihypertensive therapy until further evidence is available.

关键词： COVED-19 SARS-CoV-2 hypertension angiotensin-converting enzyme inhibitor angiotensinⅡreceptor blocker

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