Endeman Henrik, Herpers Bjorn L, de Jong Ben A W, Voorn G Paul, Grutters Jan C, van Velzen-Blad Heleen, Biesma Douwe H
Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam.
Medical Microbiology and Immunology, St. Antonius Ziekenhuis Nieuwegein, Nieuwegein, the Netherlands.
Chest. 2008 Dec;134(6):1135-1140. doi: 10.1378/chest.08-0642. Epub 2008 Jul 18.
Community-acquired pneumonia (CAP) is most frequently caused by Streptococcus pneumoniae, Haemophilus influenzae, atypical pathogens, and respiratory viruses. Susceptibility to CAP can be increased by single-nucleotide polymorphisms (SNPs) within the mannose-binding lectin (MBL) gene. We questioned whether MBL polymorphisms are associated with the susceptibility to and outcome of CAP and its most common pathogens.
All adult patients presenting with CAP in a 23-month period were included in this study. Frequencies of SNPs were determined for the promoter X/Y and the three coding SNPs in exon 1 (A/0). Six genotypes were constructed representing patients with sufficient and deficient serum levels of MBL. The results of the patients with CAP were compared with control subjects.
In 199 patients and 223 control subjects, MBL genotypes were determined. There were no differences in MBL genotype frequencies between patients with CAP in general, pneumonia caused by S pneumoniae or H influenzae, and control subjects. The frequency of sufficient MBL genotypes was nonsignificantly higher in patients with pneumonia with Legionella sp and Mycoplasma pneumoniae. In Legionella spp, the sufficient YA/YA genotype was significantly more frequent than in control subjects (odds ratio [OR], 5.43; confidence interval [CI], 1.32 to 22.41; p = 0.02). The frequency of the MBL-deficient genotype was significantly higher in patients with viral (co)infections (OR, 2.36; CI, 1.06 to 5.26; p = 0.03) and nonsignificantly higher in patients with pneumococcal pneumonia and viral (co)infections. MBL genotypes had no effect on outcome.
MBL genotypes play a limited role in pneumococcal pneumonia. Sufficient MBL genotypes were more frequently found in a small group of patients with atypical pneumonia, and MBL-deficient genotypes were more frequently found in patients with viral (co)infections.
社区获得性肺炎（CAP）最常见的病因是肺炎链球菌、流感嗜血杆菌、非典型病原体和呼吸道病毒。甘露糖结合凝集素（MBL）基因内的单核苷酸多态性（SNP）可增加对CAP的易感性。我们质疑MBL多态性是否与CAP及其最常见病原体的易感性和转归相关。
本研究纳入了在23个月期间出现CAP的所有成年患者。确定启动子X/Y和外显子1中三个编码SNP（A/0）的SNP频率。构建了六种基因型，分别代表MBL血清水平充足和不足的患者。将CAP患者的结果与对照组进行比较。
在199例患者和223例对照者中确定了MBL基因型。总体CAP患者、肺炎链球菌或流感嗜血杆菌引起的肺炎患者与对照者之间的MBL基因型频率无差异。军团菌属和肺炎支原体肺炎患者中，MBL基因型充足的频率略高，但无统计学意义。在嗜肺军团菌感染中，充足的YA/YA基因型频率显著高于对照者（优势比[OR]，5.43；置信区间[CI]，1.32至22.41；p = 0.02）。病毒（合并）感染患者中MBL缺陷基因型的频率显著更高（OR，2.36；CI，1.06至5.26；p = 0.03），肺炎链球菌肺炎合并病毒（合并）感染患者中该频率略高，但无统计学意义。MBL基因型对转归无影响。
MBL基因型在肺炎链球菌肺炎中作用有限。在一小部分非典型肺炎患者中更常发现MBL基因型充足，而在病毒（合并）感染患者中更常发现MBL缺陷基因型。
