高人类 T 淋巴细胞嗜性病毒 1 型 C 亚型前病毒载量与澳大利亚原住民的支气管扩张症有关：一项病例对照研究的结果。
Higher human T-lymphotropic virus type 1 subtype C proviral loads are associated with bronchiectasis in indigenous australians: results of a case-control study.
机构信息
Northern Territory Rural Clinical School/Flinders University , Northern Territory of Australia , Australia ; SA Pathology, Adelaide , South Australia , Australia.
Institut Pasteur, Unité EPVO, Département de Virologie , F-75015 Paris , France ; CNRS, UMR 3569 , F-75015 Paris , France.
出版信息
Open Forum Infect Dis. 2014 May 28;1(1):ofu023. doi: 10.1093/ofid/ofu023. eCollection 2014 Mar.
BACKGROUND
We previously suggested that infection with the human T-lymphotropic virus type 1 (HTLV-1) subtype C is associated with bronchiectasis among Indigenous Australians. Bronchiectasis might therefore result from an HTLV-1-mediated inflammatory process that is typically associated with a high HTLV-1 proviral load (PVL). Human T-lymphotropic virus type 1 PVL have not been reported for Indigenous Australians.
METHODS
Thirty-six Indigenous adults admitted with bronchiectasis from June 1, 2008, to December 31, 2009 were prospectively recruited and matched by age, sex, and ethno-geographic origin to 36 controls. Case notes and chest high-resolution computed tomographs were reviewed, and pulmonary injury scores were calculated. A PVL assay for the HTLV-1c subtype that infects Indigenous Australians was developed and applied to this study. Clinical, radiological, and virological parameters were compared between groups and according to HTLV-1 serostatus.
RESULTS
Human T-lymphotropic virus type 1 infection was the main predictor of bronchiectasis in a multivariable model (adjusted risk ratio [aRR], 1.84; 95% confidence interval [CI], 1.19-2.84; P = .006). Moreover, the median HTLV-1c PVL (interquartile range) for cases was >100-fold that of controls (cases, 0.319 [0.007, 0.749]; controls, 0.003 [0.000, 0.051] per 100 peripheral blood lymphocytes; P = .007), and HTLV-1c PVL were closely correlated with radiologically determined pulmonary injury scores (Spearman's rho = 0.7457; P = .0000). Other predictors of bronchiectasis were positive Strongyloides serology (aRR, 1.69; 95% CI, 1.13-2.53) and childhood skin infections (aRR, 1.62; 95% CI, 1.07-2.44). Bronchiectasis was the major predictor of death (aRR, 2.71; 95% CI, 1.36-5.39; P = .004).
CONCLUSIONS
These data strongly support an etiological association between HTLV-1 infection and bronchiectasis in a socially disadvantaged population at risk of recurrent lower respiratory tract infections.
背景
我们之前曾提出，人类 T 淋巴细胞白血病病毒 1 型（HTLV-1）亚型 C 的感染与澳大利亚原住民的支气管扩张症有关。因此，支气管扩张症可能是由 HTLV-1 介导的炎症过程引起的，这种炎症过程通常与高 HTLV-1 前病毒载量（PVL）有关。尚未报告过澳大利亚原住民的 HTLV-1 PVL。
方法
2008 年 6 月 1 日至 2009 年 12 月 31 日，我们前瞻性招募了 36 名因支气管扩张症入院的澳大利亚原住民成年人，并按年龄、性别和种族来源与 36 名对照进行了匹配。回顾病例记录和胸部高分辨率计算机断层扫描，并计算肺损伤评分。开发了一种针对感染澳大利亚原住民的 HTLV-1c 亚型的 HTLV-1 PVL 检测方法，并将其应用于本研究。比较了两组之间以及根据 HTLV-1 血清阳性状态的临床、放射学和病毒学参数。
结果
多变量模型显示，HTLV-1 感染是支气管扩张症的主要预测因素（调整后的风险比 [aRR]，1.84；95%置信区间 [CI]，1.19-2.84；P=.006）。此外，病例的中位 HTLV-1c PVL（四分位距）是对照组的 >100 倍（病例，0.319 [0.007，0.749]；对照组，0.003 [0.000，0.051]每 100 个外周血淋巴细胞；P=.007），并且 HTLV-1c PVL 与放射学确定的肺损伤评分密切相关（Spearman 相关系数=0.7457；P=.0000）。支气管扩张症的其他预测因素包括 Strongyloides 血清学阳性（aRR，1.69；95%CI，1.13-2.53）和儿童期皮肤感染（aRR，1.62；95%CI，1.07-2.44）。支气管扩张症是死亡的主要预测因素（aRR，2.71；95%CI，1.36-5.39；P=.004）。
结论
这些数据强烈支持 HTLV-1 感染与处于复发性下呼吸道感染风险中的社会弱势群体的支气管扩张症之间存在病因关联。
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