Host-pathogen interaction during pneumococcal infection in patients with chronic obstructive pulmonary disease
Host-pathogen interaction during pneumococcal infection in patients with chronic obstructive pulmonary disease
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DOI：
10.1128/iai.72.2.818-823.2004
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发表时间：
2004-02-01
影响因子：
3.1
通讯作者：
Hermans, PWM
中科院分区：
文献类型：
--
作者：
Bogaert, D;van der Valk, P;Hermans, PWM
急性加重是慢性阻塞性肺疾病（COPD）的常见并发症。最近的研究表明细菌如肺炎链球菌在急性加重的发展中的作用。在这项研究中，我们调查了COPD患者的以下情况：（i）肺炎球菌定植和感染的流行病学，（ii）肺炎球菌定植对加重发展的影响，以及（iii）对S.肺炎。我们培养了269名COPD患者在稳定状态和COPD加重期间的痰液，并通过使用血清分型对115株肺炎球菌进行了鉴定。此外，我们研究了这些患者血清免疫球蛋白G（IgG）抗体滴度、抗体亲和力和针对7种结合疫苗血清型的功能性抗体滴度。仅肺炎球菌定植（单一培养）增加了急性加重的风险，风险比为2.93（95%置信区间，1.41至6.07）。发现的最流行的肺炎球菌血清型是血清型19 F、3、14、9 L/N/V、23 A/B和11。我们计算出7价和11价肺炎球菌疫苗的理论覆盖率分别为60%和73%。所有患者均具有针对七种结合疫苗血清型的可检测IgG水平。这些抗体滴度显著低于接种疫苗的健康成人。最后，平均而言，在S.在急性加重期间观察到肺炎阳性痰培养。我们的数据表明，COPD患者中的肺炎球菌定植通常是由疫苗血清型菌株引起的。此外，肺炎球菌定植是COPD恶化的危险因素。最后，我们的研究结果表明，COPD患者能够对肺炎球菌感染产生显著的免疫反应。因此，COPD患者可从肺炎球菌疫苗接种中获益。
Acute exacerbation is a frequent complication of chronic obstructive pulmonary disease (COPD). Recent studies suggested a role for bacteria such as Streptococcus-pneumoniae in the development of acute exacerbation. For this study, we investigated the following in COPD patients: (i) the epidemiology of pneumococcal colonization and infection, (ii) the effect of pneumococcal colonization on the development of exacerbation, and (iii) the immunological response against S. pneumoniae. We cultured sputa of 269 COPD patients during a stable state and during exacerbation of COPD and characterized 115 pneumococcal isolates by use of serotyping. Moreover, we studied serum immunoglobulin G (IgG) antibody titers, antibody avidities, and functional antibody titers against the seven conjugate vaccine serotypes in these patients. Colonization with only pneumococci (monocultures) increased the risk of exacerbation, with a hazard ratio of 2.93 (95% confidence interval, 1.41 to 6.07). The most prevalent pneumococcal serotypes found were serotypes 19F, 3, 14, 9L/N/V, 23A/B, and 11. We calculated the theoretical coverage for the 7-and 11-valent pneumococcal vaccines to be 60 and 73%, respectively. All patients had detectable IgG levels against the seven conjugate vaccine serotypes. These antibody titers were significantly lower than those in vaccinated healthy adults. Finally, on average, a 2.5-fold rise in serotype-specific and functional antibodies in S. pneumoniae-positive sputum cultures was observed during exacerbation. Our data indicate that pneumococcal colonization in COPD patients is frequently caused by vaccine serotype strains. Moreover, pneumococcal colonization is a risk factor for exacerbation of COPD. Finally, our findings demonstrate that COPD patients are able to mount a significant immune response to pneumococcal infection. COPD patients may therefore benefit from pneumococcal vaccination.