Chen Liang-Yu, Hwang An-Chun, Huang Chung-Yu, Chen Liang-Kung, Wang Fu-Der, Chan Yu-Jiun
Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.
Aging and Health Research Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St, Taipei, 11221, Taiwan.
Immun Ageing. 2021 May 4;18(1):21. doi: 10.1186/s12979-021-00233-0.
Chronic infections played a detrimental role on health outcomes in the aged population, and had complex associations with lymphocyte subsets distribution. Our study aimed to explore the predictive roles of chronic infections, lymphopenia, and lymphocyte subsets on unexpected admission and mortality in the institutionalized oldest-old during 3 year follow-up period.
There were 163 participants enrolled prospectively with median age of 87.3 years (IQR: 83.1-90.2), male of 88.3%, and being followed for 156.4 weeks (IQR: 136.9-156.4 weeks). The unexpected admission and mortality rates were 55.2 and 24.5% respectively. The Cox proportional hazards models demonstrated the 3rd quartile of cytomegalovirus IgG (OR: 3.26, 95% CI: 1.55-6.84), lymphopenia (OR: 2.85, 95% CI: 1.2-6.74), and 1st quartile of CD19 B cell count (OR: 2.84, 95% CI: 1.29-6.25) predicted elevated risks of unexpected admission after adjusting for potential confounders; while the 3rd quartile of CD3 T cell indicated a reduced risk of mortality (OR: 0.19, 95% CI: 0.05-0.71). Negative association between CMV IgG and CD19 B cell count suggested that CMV infection might lead to B cell depletion via decreasing memory B cells repertoire.
CMV infection, lymphopenia, and CD19 B cell depletion might predict greater risk of unexpected admission, while more CD3 T cell would suggest a reduced risk of mortality among the oldest-old population. A non-linear or U-shaped relationship was supposed between health outcomes and CMV infection, CD3 T cell, or CD19 B cell counts. Further prospective studies with more participants included would be needed to elucidate above findings.
慢性感染对老年人群的健康结局有不利影响，且与淋巴细胞亚群分布存在复杂关联。我们的研究旨在探讨慢性感染、淋巴细胞减少症和淋巴细胞亚群在3年随访期内对机构养老的高龄老人意外入院和死亡的预测作用。
前瞻性纳入163名参与者，中位年龄87.3岁（四分位间距：83.1 - 90.2岁），男性占88.3%，随访156.4周（四分位间距：136.9 - 156.4周）。意外入院率和死亡率分别为55.2%和24.5%。Cox比例风险模型显示，在调整潜在混杂因素后，巨细胞病毒IgG的第3四分位数（比值比：3.26，95%置信区间：1.55 - 6.84）、淋巴细胞减少症（比值比：2.85，95%置信区间：1.2 - 6.74）以及CD19 B细胞计数的第1四分位数（比值比：2.84，95%置信区间：1.29 - 6.25）可预测意外入院风险升高；而CD3 T细胞的第3四分位数提示死亡风险降低（比值比：0.19，95%置信区间：0.05 - 0.71）。巨细胞病毒IgG与CD19 B细胞计数之间的负相关表明，巨细胞病毒感染可能通过减少记忆B细胞库导致B细胞耗竭。
巨细胞病毒感染、淋巴细胞减少症和CD19 B细胞耗竭可能预示高龄老人意外入院风险更高，而更多的CD3 T细胞提示死亡风险降低。健康结局与巨细胞病毒感染、CD3 T细胞或CD19 B细胞计数之间可能存在非线性或U型关系。需要纳入更多参与者进行进一步的前瞻性研究以阐明上述发现。
