Respiratory Medicine, University Hospital of Liege, CHU Sart-Tilman B35, GIGA I3 Lab, Liège, Belgium.
Clinical Microbiology, University Hospital of Liege, CHU Sart-Tilman B35, Liège, Belgium.
Respir Res. 2021 Feb 26;22(1):72. doi: 10.1186/s12931-021-01635-w.
Chlamydia pneumoniae and Mycoplasma pneumoniae have been implicated in the pathogenesis of asthma and are responsible for chronic inflammation when host immune system fails to eradicate the bacteria.
We performed a prospective study on 410 patients who underwent a visit at the asthma clinic of CHU of Liege between June 2016 and June 2018 with serology testing for C. pneumoniae and M. pneumoniae.
65% of our asthmatic population had serum IgA and/or IgG towards C. pneumoniae, while only 12.6% had IgM and/or IgG against M. pneumoniae. Compared to seronegative asthmatics, asthmatics with IgA+ and IgG+ against C. pneumoniae were more often male and older with a higher proportion of patients with smoking history. They received higher doses of inhaled corticosteroids (ICS) and displayed lower FEV/FVC ratio, higher RV/TLC ratio and lower conductance. They had higher levels of fibrinogen, though in the normal range and had lower sputum eosinophil counts. Patients with IgA- and IgG+ against C. pneumoniae were older and had higher blood monocyte counts and alpha-1-antitrypsin levels as compared to seronegative patients. Patients with IgM and/or IgG towards M. pneumoniae were more often males than seronegative asthmatics. In a subpopulation of 14 neutrophilic asthmatics with Chlamydia pneumoniae IgA + /IgG + treated with macrolides, we found a significant decrease in blood neutrophils and normalization of sputum neutrophil count but no effect on asthma quality of life and exacerbations.
Positive Chlamydia serologic test is more common than positive Mycoplasma serology. Asthmatics with IgA and IgG against C. pneumoniae have more severe disease with increased airway obstruction, higher doses of ICS, more signs of air trapping and less type-2 inflammation.
肺炎衣原体和肺炎支原体与哮喘的发病机制有关，当宿主免疫系统未能清除细菌时，它们会导致慢性炎症。
我们对 2016 年 6 月至 2018 年 6 月期间在列日 CHU 哮喘诊所就诊的 410 例患者进行了前瞻性研究，对这些患者进行了肺炎衣原体和肺炎支原体血清学检测。
我们哮喘人群中有 65%的人对肺炎衣原体有血清 IgA 和/或 IgG，而只有 12.6%的人对肺炎支原体有 IgM 和/或 IgG。与血清阴性哮喘患者相比，对肺炎衣原体 IgA+和 IgG+的哮喘患者更多为男性和老年人，有吸烟史的患者比例更高。他们接受了更高剂量的吸入性皮质类固醇（ICS），且 FEV/FVC 比值较低，RV/TLC 比值较高，传导率较低。他们的纤维蛋白原水平较高，但在正常范围内，痰中嗜酸性粒细胞计数较低。与血清阴性患者相比，对肺炎衣原体 IgA-和 IgG+的患者年龄更大，血液单核细胞计数和α-1-抗胰蛋白酶水平更高。对肺炎支原体有 IgM 和/或 IgG 的患者中，男性多于血清阴性哮喘患者。在 14 例中性粒细胞性哮喘患者的亚组中，他们对肺炎衣原体 IgA+和 IgG+，并用大环内酯类药物治疗，我们发现血液中性粒细胞减少，痰中性粒细胞计数正常，但对哮喘生活质量和加重没有影响。
肺炎衣原体血清学检测阳性比肺炎支原体血清学检测阳性更常见。对肺炎衣原体有 IgA 和 IgG 的哮喘患者疾病更严重，气道阻塞更严重，ICS 剂量更高，空气潴留迹象更多，2 型炎症更少。
