Nenna Raffaella, Zhai Jing, Packard Samuel E, Spangenberg Amber, Sherrill Duane L, Martinez Fernando D, Halonen Marilyn, Guerra Stefano
Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA.
Dept of Pediatrics, "Sapienza" University of Rome, Rome, Italy.
ERJ Open Res. 2020 Apr 27;6(2). doi: 10.1183/23120541.00062-2020. eCollection 2020 Apr.
Positive serology for cytomegalovirus (CMV) has been associated with all-cause mortality risk but its role in COPD mortality is unknown. The objective of the present study was to assess the relationship between CMV serology and COPD mortality.
We analysed data from 806 participants in the Tucson Epidemiological Study of Airway Obstructive Disease who, at enrolment, were aged 28-70 years and had completed lung function tests. We tested CMV serology in sera from enrolment and defined "high CMV serology" as being in the highest tertile. Vital status, date and cause of death were assessed through death certificates and/or linkage with the National Death Index up to January 2017. The association of CMV serology with all-cause and cause-specific mortality risk was tested in Cox models adjusted for age, sex, level of education, body mass index, smoking status and pack-years.
High CMV serology was marginally associated with all-cause mortality (p=0.071) but the effect was inversely dependent on age, with the association being much stronger among participants <55 years than among participants ≥55 years at enrolment (p-value for CMV-by-age interaction <0.001). Compared with low CMV serology, high CMV serology was associated with mortality from COPD among all subjects (adjusted hazard ratio (HR) 2.38, 95% CI 1.11-5.08; p=0.025) and particularly in subjects <55 years old at enrolment (HR 5.40, 95% CI 1.73-16.9; p=0.004). Consistent with these results, high CMV serology also predicted mortality risk among subjects who already had airflow limitation at enrolment (HR 2.10, 95% CI 1.20-3.68; p=0.009).
We report a strong relationship between CMV serology and the risk of dying from COPD, and thus identify a novel risk factor for COPD mortality.
巨细胞病毒（CMV）血清学阳性与全因死亡风险相关，但其在慢性阻塞性肺疾病（COPD）死亡中的作用尚不清楚。本研究的目的是评估CMV血清学与COPD死亡率之间的关系。
我们分析了图森气道阻塞性疾病流行病学研究中806名参与者的数据，这些参与者在入组时年龄为28 - 70岁，并完成了肺功能测试。我们检测了入组时血清中的CMV血清学，并将“高CMV血清学”定义为处于最高三分位数。通过死亡证明和/或与截至2017年1月的国家死亡指数的关联来评估生命状态、死亡日期和死因。在根据年龄、性别、教育水平、体重指数、吸烟状况和吸烟包年数进行调整的Cox模型中，测试CMV血清学与全因和特定病因死亡风险的关联。
高CMV血清学与全因死亡率有微弱关联（p = 0.071），但其影响与年龄呈负相关，在入组时年龄<55岁的参与者中这种关联比年龄≥55岁的参与者中更强（CMV与年龄交互作用的p值<0.001）。与低CMV血清学相比，高CMV血清学与所有受试者的COPD死亡率相关（调整后的风险比（HR）为2.38，95%置信区间为1.11 - 5.08；p = 0.025），特别是在入组时年龄<55岁的受试者中（HR为5.40，95%置信区间为1.73 - 16.9；p = 0.004）。与这些结果一致，高CMV血清学也预测了入组时已有气流受限的受试者的死亡风险（HR为2.10，95%置信区间为1.20 - 3.68；p = 0.009）。
我们报告了CMV血清学与死于COPD风险之间的密切关系，从而确定了一种新的COPD死亡风险因素。
