癌症患者脾脏体积与肺炎球菌感染风险之间无关联：一项巢式病例对照研究。
Lack of an association between spleen volume and risk of pneumococcal infection in cancer patients: a nested case-control study.
作者信息
Kurihara Ibuki, Yamazaki Hajime, Kato Sakura, Oyama-Manabe Noriko, Sugawara Hitoshi
机构信息
Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, 330-8503, Saitama, Japan.
Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
出版信息
BMC Infect Dis. 2024 Dec 18;24(1):1437. doi: 10.1186/s12879-024-10328-w.
BACKGROUND
The spleen is a key organ in preventing pneumococcal infection, especially in patients with immunocompromised condition such as those with cancer. Previous studies have shown that a small spleen volume in pneumococcal pneumonia patients is associated with severe disease course. However, it is unknown whether a small spleen increases risk of pneumococcal infection. We investigated the association between spleen volume and risk of pneumococcal infection.
METHODS
This study was a retrospective cohort study using a nested case-control design and involved adult patients with malignancy who underwent chest and/or abdominal CT scans from January 1, 2008, to September 30, 2020, at a tertiary care center in Japan. Exclusion criteria comprised patients diagnosed with hepatic cirrhosis, leukemia, lymphoma, and/or post-splenectomy. From the cohort group that met all selection criteria (n = 22475), we identified all incident cases of pneumococcal infection (pneumococcal pneumonia and/or invasive pneumococcal diseases) and matched them with four controls by age, sex, and follow-up duration. Odds ratios (ORs) for the association between spleen volume and pneumococcal infection were estimated using conditional logistic regression models adjusted for body surface area, performance status, Charlson comorbidity index, and metastatic cancer.
RESULTS
The median spleen volume was 85.8 (interquartile range, 65.8-120.8) cm. Over a median follow-up of 4.95 (interquartile range, 1.54-9.25) years, 60 patients were diagnosed with pneumococcal infection (20 with invasive pneumococcal disease and 40 with pneumonia without invasive pneumococcal disease) and matched with 240 controls. Spleen volume reduction (per 10 cm) did not increase risk of pneumococcal infection in a crude analysis [OR 1.04 (95% CI 0.98-1.11)]. The outcome remained unchanged in the multivariable analysis (OR 1.01 [95% CI 0.95-1.08]).
CONCLUSIONS
Small spleen volume did not increase risk of pneumococcal infection in cancer patients.
背景
脾脏是预防肺炎球菌感染的关键器官，尤其是在免疫功能低下的患者中，如癌症患者。既往研究表明，肺炎球菌肺炎患者的脾脏体积小与病程严重有关。然而，脾脏小是否会增加肺炎球菌感染的风险尚不清楚。我们调查了脾脏体积与肺炎球菌感染风险之间的关联。
方法
本研究是一项采用巢式病例对照设计的回顾性队列研究，纳入了2008年1月1日至2020年9月30日在日本一家三级医疗中心接受胸部和/或腹部CT扫描的成年恶性肿瘤患者。排除标准包括诊断为肝硬化、白血病、淋巴瘤和/或脾切除术后的患者。从符合所有入选标准的队列组（n = 22475）中，我们确定了所有肺炎球菌感染（肺炎球菌肺炎和/或侵袭性肺炎球菌疾病）的发病病例，并按年龄、性别和随访时间与4名对照进行匹配。使用调整了体表面积、体能状态、Charlson合并症指数和转移性癌症的条件逻辑回归模型估计脾脏体积与肺炎球菌感染之间关联的比值比（OR）。
结果
脾脏体积中位数为85.8（四分位间距，65.8 - 120.8）cm³。在中位随访4.95（四分位间距，1.54 - 9.25）年期间，60例患者被诊断为肺炎球菌感染（20例为侵袭性肺炎球菌疾病，40例为无侵袭性肺炎球菌疾病的肺炎），并与240名对照进行匹配。在粗分析中，脾脏体积减小（每10 cm³）并未增加肺炎球菌感染风险[OR 1.04（95%CI 0.98 - 1.11）]。多变量分析结果不变（OR 1.01 [95%CI 0.95 - 1.08]）。
结论
脾脏体积小并未增加癌症患者肺炎球菌感染的风险。
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