Moraxella catarrhalis in chronic obstructive pulmonary disease -: Burden of disease and immune response
Moraxella catarrhalis in chronic obstructive pulmonary disease -: Burden of disease and immune response
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DOI：
10.1164/rccm.200412-1747oc
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发表时间：
2005-07-15
影响因子：
24.7
通讯作者：
Sethi, S
中科院分区：
文献类型：
--
作者：
Murphy, TF;Brauer, AL;Sethi, S
理论基础：卡他莫拉菌经常出现在患有慢性阻塞性肺疾病(COPD)的成年人的痰中。对卡氏支原体在这种常见疾病中的作用知之甚少。目的：探讨慢性阻塞性肺疾病(COPD)患者的疾病负担、携带动力学和卡他支原体的免疫反应。方法：对布法罗退伍军人事务医疗中心门诊的104名成年COPD患者进行前瞻性队列研究。测量：临床信息、痰培养、分离株的分子分型，以及用于测量卡他分支杆菌抗体的免疫分析。主要结果：在81个月的时间里，104名患者进行了3,009次门诊，其中560名患者在病情恶化期间就诊。分子分型在50名患者中发现了120例卡他支原体的获得和清除；其中57例(47.5%)与临床恶化有关。没有观察到同时获得另一种病原体的新菌株的情况。卡氏支原体的携带持续时间随病情加重而缩短(中位数，31.0天对40.4天；p=0.01)。再次获得相同毒株的情况很少见。病情加重后血清免疫球蛋白反应强度高于无症状定植(p=0.009)。无症状的定植与痰免疫球蛋白A应答的频率高于病情恶化(p 0.009)。结论：卡他命支原体可能导致大约10%的COPD恶化，每年约有200万至400万次发作。在短时间的运输后，有机体被有效地清除。患者在卡特氏支原体从呼吸道中清除后产生了菌株特异性保护。
Rationale: Moraxella catarrhalis is frequently present in the sputum of adults with chronic obstructive pulmonary disease (COPD). Little is known about the role of M. catarrhalis in this common disease. Objective: To elucidate the burden of disease, the dynamics of carriage, and immune responses to M. catarrhalis in COPD. Methods: Prospective cohort study of 104 adults with COPD in an outpatient clinic at the Buffalo Veterans Affairs Medical Center. Measurements: Clinical information, sputum cultures, molecular typing of isolates, and immunoassays to measure antibodies to M. catarrhalis. Main Results: Over 81 months, 104 patients made 3,009 clinic visits, 560 during exacerbations. Molecular typing identified 120 episodes of acquisition and clearance of M. catarrhalis in 50 patients; 57 (47.5%) of the acquisitions were associated with clinical exacerbations. No instances of simultaneous acquisition of a new strain of another pathogen were observed. The duration of carriage of M. catarrhalis was shorter with exacerbations compared with asymptomatic colonization (median, 31.0 vs. 40.4 days; p = 0.01). Reacquisition of the same strain was rare. The intensity of the serum IgG response was greater after exacerbations than asymptomatic colonization (p = 0.009). Asymptomatic colonization was associated with a greater frequency of a sputum IgA response than exacerbation (p 0.009). Conclusions: M. catarrhalis likely causes approximately 10% of exacerbations of COPD, accounting for approximately 2 to 4 million episodes annually. The organism is cleared efficiently after a short duration of carriage. Patients develop strain-specific protection after clearance of M. catarrhalis from the respiratory tract.