Risk Factors of Pneumonia in Primary Antibody Deficiency Patients Receiving Immunoglobulin Therapy: Data from the US Immunodeficiency Network (USIDNET).
Risk Factors of Pneumonia in Primary Antibody Deficiency Patients Receiving Immunoglobulin Therapy: Data from the US Immunodeficiency Network (USIDNET).
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接受免疫球蛋白治疗的原发性抗体缺乏患者肺炎的危险因素：来自美国免疫缺陷网络 (USIDNET) 的数据。
DOI：
10.1007/s10875-022-01317-2
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发表时间：
2022
影响因子：
9.1
通讯作者：
Hajjar,Joud
中科院分区：
文献类型：
--
作者：
Syed,MahaN;Kutac,Carleigh;Miller,JenniferM;Marsh,Rebecca;Sullivan,KathleenE;Cunningham-Rundles,Charlotte;Fuleihan,RamsayL;Kheradmand,Farrah;Hajjar,Joud
尽管免疫球蛋白替代（IgRT）治疗，一些一抗缺乏症（PAD）患者继续发展为呼吸道感染。复发性和严重的呼吸道感染，特别是肺炎，可导致严重的发病率和死亡率。因此，我们试图确定已经接受IgRT的PAD患者发生肺炎的危险因素。方法：我们评估了截至2017年4月在美国免疫缺陷网络（USIDNET）注册的PAD患者的临床和实验室特征。如果患者符合以下标准，则纳入：(1)PAD诊断（常见可变免疫缺陷（CVID），无球蛋白血症，低γ -球蛋白血症和特异性抗体缺乏症（SAD））； (2) IgRT前后感染的可用数据。如果患者没有接受IgRT，或者没有可用的感染前后数据，则将其排除在外。采用描述性和多变量logistic回归分析确定与igrt后肺炎相关的因素。结果1232例患者符合纳入标准。IgRT后，218例患者（17.7%）报告至少有一次肺炎发作。使用多元逻辑回归分析,我们发现了一个显著的风险增加肺炎患者的哮喘(OR: 2.55, 95% CI (1.69 - -3.85), p < 0.001)支气管扩张(OR: 3.94, 95% CI (2.29 - -6.80), p < 0.001),间质性肺病(ILD) (OR: 3.28, 95% CI (1.43 - -7.56), p < 0.005),脾肿大(OR: 2.02, 95% CI (1.08 - -3.76), p < 0.027),过敏(OR: 2.44, 95% CI [1.44 - -4.13], p = 0.001),和病人不是immunosuppressives (OR: 1.61; 95%可信区间(1.06 - -2.46);p = 0.027)。IgA每增加50个单位，IgRT后报告肺炎的几率降低（OR: 0.86, 95% CI [0.73-1.02],p= 0.062）。218例IgRT后报告肺炎的患者中有35例报告了感染性微生物。报告最多的是流感嗜血杆菌（11例，31.43%），其次是肺炎链球菌（7例，20.00%）。结论伴有慢性和结构性肺部疾病、脾肿大和过敏的PAD患者与持续性肺炎相关。然而，我们的研究受到USIDNET数据库的横断面性质和有限的纵向数据的限制。有必要进行进一步的研究，以确定易受影响的原因，并探索预防和相关发病率和死亡率的有针对性的解决方案。伴有结构性肺部疾病、过敏和脾肿大的一抗缺乏患者与igrt后持续性肺炎相关。
BackgroundDespite immunoglobulin replacement (IgRT) therapy, some patients with primary antibody deficiency (PAD) continue to develop respiratory infections. Recurrent and severe respiratory infections, particularly pneumonia, can lead to significant morbidity and mortality. Therefore, we sought to determine the risk factors of developing pneumonia in PAD patients, already receiving IgRT.MethodsWe evaluated clinical and laboratory features of PAD patients enrolled in the US Immune Deficiency Network (USIDNET) registry by April 2017. Patients were included if they met the following criteria: (1) PAD diagnosis (common variable immunodeficiency (CVID), agammaglobulinemia, hypogammaglobinemia, and specific antibody deficiency (SAD) and (2) available data on infections before and after IgRT. Patients were excluded if they were not receiving IgRT, or if no pre/post infections data were available. Descriptive and multivariable logistic regression analyses were used to identify factors associated with pneumonia post-IgRT.ResultsA total of 1232 patients met the inclusion criteria. Following IgRT, 218 patients (17.7%) were reported to have at least one pneumonia episode. Using multivariate logistic regression analysis, we found a statistically significant increased risk of pneumonia in patients with asthma (OR: 2.55, 95% CI (1.69–3.85), p < 0.001) bronchiectasis (OR: 3.94, 95% CI (2.29–6.80),p< 0.001), interstitial lung disease (ILD) (OR: 3.28, 95%CI (1.43–7.56),p< 0.005), splenomegaly (OR: 2.02, 95%CI (1.08–3.76),p< 0.027), allergies (OR: 2.44, 95% CI [1.44–4.13],p= 0.001), and patients who were not on immunosuppressives (OR: 1.61; 95%CI [1.06–2.46];p= 0.027). For every 50 unit increase in IgA, the odds of reporting pneumonia post IgRT decreased (OR: 0.86, 95% CI [0.73–1.02],p= 0.062).Infectious organisms were reported in 35 of 218 patients who reported pneumonia after IgRT.Haemophilus influenzaewas the most frequently reported (n= 11, 31.43%), followed byStreptococcus pneumoniae(n= 7, 20.00%).ConclusionOur findings suggest PAD patients with chronic and structural lung disease, splenomegaly, and allergies were associated with persistent pneumonia. However, our study is limited by the cross-sectional nature of the USIDNET database and limited longitudinal data. Further studies are warranted to identify susceptible causes and explore targeted solutions for prevention and associated morbidity and mortality.Clinical ImplicationsPatients with primary antibody deficiency with structural lung disease, allergies, and splenomegaly are associated with persistent pneumonia post-IgRT.
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DOI：
10.1056/nejm198612043152306
发表时间：
1986-12
期刊：
The New England journal of medicine
影响因子：
--
作者：
J. Marshall;R. Kelch
通讯作者：
J. Marshall;R. Kelch
灵长类支持细胞的抑制素快速而深刻地抑制编码促卵泡激素β的信使核糖核酸。
DOI：
10.1210/mend-3-2-280
发表时间：
1989
期刊：
Molecular endocrinology (Baltimore, Md.)
影响因子：
--
作者：
Attardi,B;Keeping,HS;Winters,SJ;Kotsuji,F;Maurer,RA;Troen,P
通讯作者：
Troen,P
睾酮差异性地调节促性腺激素亚基信使核糖核酸对促性腺激素释放激素脉冲幅度的反应。
影响因子：
4.8
作者：
Iliff-Sizemore,SA;Ortolano,GA;Haisenleder,DJ;Dalkin,AC;Krueger,KA;Marshall,JC
通讯作者：
Marshall,JC
色谱聚焦法测定大鼠 FSH 的异质性：血清 FSH、体外释放激素及其各种形式代谢清除率的研究。
影响因子：
4
作者：
W. Blum;D. Gupta
通讯作者：
D. Gupta
减少促性腺激素释放激素刺激的频率对促性腺激素释放激素缺乏的男性和灌注的大鼠垂体细胞中促性腺激素分泌的影响。
DOI：
10.1172/jci113512
发表时间：
1988
期刊：
The Journal of clinical investigation
影响因子：
--
作者：
Finkelstein,JS;Badger,TM;O'Dea,LS;Spratt,DI;Crowley,WF
通讯作者：
Crowley,WF