Eisen Damon P, Dean Melinda M, Thomas Peter, Marshall Penny, Gerns Natalie, Heatley Sue, Quinn Josephine, Minchinton Robyn M, Lipman Jeff
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Vic, Australia.
FEMS Immunol Med Microbiol. 2006 Nov;48(2):274-82. doi: 10.1111/j.1574-695X.2006.00144.x.
Mannose-binding lectin (MBL) is an innate immune system pattern recognition molecule that kills a wide range of pathogens via the lectin complement pathway. MBL deficiency is associated with severe infection but the best measure of this deficiency is undecided. We investigated the influence of MBL functional deficiency on the development of sepsis in 195 adult patients, 166 of whom had bloodstream infection and 35 had pneumonia. Results were compared with 236 blood donor controls. MBL function (C4b deposition) and levels were measured by enzyme-linked immunosorbent assay. Using receiver-operator characteristics of MBL function in healthy controls, we identified a level of <0.2 U microL(-1) as a highly discriminative marker of low MBL2 genotypes. Median MBL function was lower in sepsis patients (0.18 U microL(-1)) than in controls (0.48 U microL(-1), P<0.001). MBL functional deficiency was more common in sepsis patients than controls (P<0.001). MBL functional deficient patients had significantly higher sequential organ failure assessment (SOFA) scores and higher MBL function and levels were found in patients with SOFA scores predictive of good outcome. Deficiency of MBL function appears to be associated with bloodstream infection and the development of septic shock. High MBL levels may be protective against severe sepsis.
甘露糖结合凝集素（MBL）是一种先天性免疫系统模式识别分子，可通过凝集素补体途径杀死多种病原体。MBL缺乏与严重感染相关，但这种缺乏的最佳检测方法尚无定论。我们调查了195例成年患者中MBL功能缺陷对脓毒症发展的影响，其中166例有血流感染，35例有肺炎。将结果与236名献血者对照进行比较。通过酶联免疫吸附测定法测量MBL功能（C4b沉积）和水平。利用健康对照中MBL功能的受试者工作特征曲线，我们确定<0.2 U μL（-1）的水平为低MBL2基因型的高度判别标志物。脓毒症患者的MBL功能中位数（0.18 U μL（-1））低于对照组（0.48 U μL（-1），P<0.001）。MBL功能缺陷在脓毒症患者中比对照组更常见（P<0.001）。MBL功能缺陷的患者序贯器官衰竭评估（SOFA）评分显著更高，而在预测预后良好的SOFA评分患者中发现更高的MBL功能和水平。MBL功能缺陷似乎与血流感染和感染性休克的发展有关。高MBL水平可能对严重脓毒症有保护作用。
