Unpacking the 'black box' of total pathogen burden: is number or type of pathogens most predictive of all-cause mortality in the United States?
Unpacking the 'black box' of total pathogen burden: is number or type of pathogens most predictive of all-cause mortality in the United States?
复制标题
揭开病原体总负担的“黑匣子”：病原体的数量或类型最能预测美国的全因死亡率吗？
DOI：
10.1017/s0950268814003215
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发表时间：
2015
影响因子：
4.2
通讯作者：
Aiello,AE
中科院分区：
文献类型：
--
作者：
Simanek,AM;Dowd,JB;Zajacova,A;Aiello,AE
一个“黑箱”的范例已经盛行，其中研究人员集中在病原体的总数，其中个人是血清阳性（即总病原体负担）和各种慢性疾病之间的关联，而在很大程度上忽略了病原体的特定组合的血清阳性可能在这些结果的病因学中发挥的作用，因此死亡率。我们研究了美国总病原体负担以及特定病原体组合与全因死亡率之间的关系。数据来自于接受巨细胞病毒（CMV）、单纯疱疹病毒（HSV）-1、HSV-2和幽门螺杆菌检测的年龄≥ 25岁的个体，死亡率随访至2006年12月31日，国家健康与营养调查（NHANES）III（N = 6522）。我们没有观察到总病原体负荷水平和全因死亡率之间存在统计学显著的分级关系。此外，与所有四种病原体血清阴性的患者相比，CMV+/HSV-2+患者的全因死亡率最高（风险比1.95，95%置信区间1.13 - 3.35），调整了年龄、性别、种族/民族、教育水平、体重指数（kg/m2）和吸烟状况。以预防或治疗特定病原体为目标的干预措施可能比仅侧重于减少总体病原体负担的干预措施更有效地降低死亡率。
A ‘black box’ paradigm has prevailed in which researchers have focused on the association between the total number of pathogens for which individuals are seropositive (i.e. total pathogen burden) and various chronic diseases, while largely ignoring the role that seropositivity for specific combinations of pathogens may play in the aetiology of such outcomes and consequently mortality. We examined the association between total pathogen burden as well as specific pathogen combinations and all-cause mortality in the United States. Data were from individuals aged ⩾25 years tested for cytomegalovirus (CMV), herpes simplex virus (HSV)-1, HSV-2 and Helicobacter pylori, with mortality follow-up to 31 December 2006 in the National Health and Nutrition Examination Survey (NHANES) III (N = 6522). We did not observe a statistically significant graded relationship between total pathogen burden level and all-cause mortality. Furthermore, compared to those seronegative for all four pathogens, the greatest statistically significant rate of all-cause mortality was for those CMV+/HSV-2+ (hazard ratio 1·95, 95% confidence interval 1·13–3·35) adjusting for age, gender, race/ethnicity, education level, body mass index (kg/m2) and smoking status. Interventions targeting prevention or treatment of particular pathogens may be more effective for reducing mortality than those focused solely on reducing overall pathogen burden.