接种流感疫苗的老年人中流感疾病的临床和免疫预测因素。
Clinical and immunologic predictors of influenza illness among vaccinated older adults.
机构信息
Division of Infectious Diseases, Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA.
出版信息
Vaccine. 2010 Aug 31;28(38):6145-51. doi: 10.1016/j.vaccine.2010.07.036. Epub 2010 Jul 31.
Abstract
The diagnosis of influenza is often missed in older adults and illness presentation may be modified by prior vaccination. We evaluated the symptoms and immunologic markers predicting laboratory-confirmed influenza (LCI) among vaccinated older adults. In subjects with influenza-like illness (ILI), fever distinguished subjects with laboratory-confirmed influenza (LCI) from those with other ILI (39% vs. 12.5%, p=0.009). In LCI subjects who did not seroconvert to influenza infection, pre-infection levels of the cytolytic mediator, granzyme B, correlated with fever (r=1.000; p=0.01) and the IFN-gamma:IL-10 ratio (r=0.999; p=0.03), and increased following influenza infection in LCI vs. ILI subjects (p=0.03). The cell-mediated immune response to influenza distinguishes A/H3N2 LCI from other ILI in older adults, and suggests a link between cell-mediated immunity and influenza illness severity in vaccinated older adults.
摘要
流感的诊断在老年人中常常被漏诊，且发病表现可能因先前的疫苗接种而改变。我们评估了预测接种老年人中实验室确诊流感（LCI）的症状和免疫标志物。在流感样疾病（ILI）患者中，发热将实验室确诊流感（LCI）患者与其他 ILI 患者区分开来（39%比 12.5%，p=0.009）。在未发生流感感染而未产生血清转换的 LCI 患者中，感染前细胞溶解介质颗粒酶 B 的水平与发热相关（r=1.000；p=0.01），与 IFN-γ：IL-10 比值相关（r=0.999；p=0.03），且在 LCI 患者中比 ILI 患者感染流感后增加（p=0.03）。针对流感的细胞免疫反应将 A/H3N2 LCI 与老年人中的其他 ILI 区分开来，并提示在接种老年人中细胞免疫与流感严重程度之间存在关联。
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