Vekemans M, Robinson J, Georgala A, Heymans C, Muanza F, Paesmans M, Klastersky J, Barette M, Meuleman N, Huet F, Calandra T, Costantini S, Ferrant A, Mathissen F, Axelsen M, Marchetti O, Aoun M
Infectious Diseases Department, Institut Jules Bordet, Brussels, Belgium.
Clin Infect Dis. 2007 Jun 15;44(12):1593-601. doi: 10.1086/518171. Epub 2007 May 10.
Mannose-binding lectin (MBL) is a serum lectin involved in innate immune response. Low serum MBL concentration may constitute a risk factor for infection in patients receiving myelosuppressive chemotherapy.
We conducted a prospective, observational study that assessed MBL concentration as a risk factor for infection in patients with hematological malignancy who were hospitalized to undergo at least 1 chemotherapy cycle. MBL deficiency was defined using an algorithm that considered the serum MBL concentration and the MBL genotype. The primary end point was the ratio of duration of febrile neutropenia to the duration of neutropenia. Secondary end points included the incidence of severe infection (e.g., sepsis, pneumonia, bacteremia, and invasive fungal infection). Logistic regression analysis was conducted, and Fisher's exact test was used to analyze binary outcomes, and Kaplan-Meier estimates and log rank tests were used for time-to-event variables.
We analyzed 255 patients who received 569 cycles of chemotherapy. The median duration of neutropenia per cycle was 7 days (interquartile range, 0-13 days). Sixty-two patients (24%) were found to have MBL deficiency. Febrile neutropenia occurred at least once in 200 patients. No difference in the primary outcome was seen. The incidence of severe infection was higher among MBL-deficient patients than among non-MBL-deficient patients (1.96 vs. 1.34 cases per 100 days for analysis of all patients [P=.008] and 1.85 vs. 0.94 cases per 100 days excluding patients with acute leukemia [P<.001]).
MBL deficiency does not predispose adults with hematological cancer to more-frequent or more-prolonged febrile episodes during myelosuppressive chemotherapy, but MBL-deficient patients have a greater number of severe infections and experience their first severe infection earlier, compared with nondeficient patients.
甘露糖结合凝集素（MBL）是一种参与固有免疫反应的血清凝集素。血清MBL浓度低可能是接受骨髓抑制化疗患者发生感染的一个危险因素。
我们进行了一项前瞻性观察性研究，评估MBL浓度作为住院接受至少1个化疗周期的血液系统恶性肿瘤患者发生感染的危险因素。使用一种考虑血清MBL浓度和MBL基因型的算法定义MBL缺乏。主要终点是发热性中性粒细胞减少持续时间与中性粒细胞减少持续时间的比值。次要终点包括严重感染（如败血症、肺炎、菌血症和侵袭性真菌感染）的发生率。进行了逻辑回归分析，采用Fisher精确检验分析二元结果，采用Kaplan-Meier估计和对数秩检验分析事件发生时间变量。
我们分析了接受569个化疗周期的255例患者。每个周期中性粒细胞减少的中位持续时间为7天（四分位间距，0 - 13天）。发现62例患者（24%）存在MBL缺乏。200例患者至少发生过一次发热性中性粒细胞减少。主要结局未见差异。MBL缺乏患者的严重感染发生率高于非MBL缺乏患者（所有患者分析中每100天分别为1.96例和1.34例[P = 0.008]，排除急性白血病患者后每100天分别为1.85例和0.94例[P < 0.001]）。
MBL缺乏不会使成年血液系统癌症患者在骨髓抑制化疗期间更频繁或更长时间地发生发热性发作，但与非缺乏患者相比，MBL缺乏患者有更多的严重感染且首次严重感染出现更早。
