von Hertzen L, Isoaho R, Leinonen M, Koskinen R, Laippala P, Töyrylä M, Kivelä S L, Saikku P
Department of Respiratory Bacterial Infections, National Public Health Institute, FIN-00300 Helsinki, Finland.
Int J Epidemiol. 1996 Jun;25(3):658-64. doi: 10.1093/ije/25.3.658.
The significance of persistent or recurrent respiratory infections in adult life for the development of chronic obstructive pulmonary disease (COPD) is still to a large extent unknown. A few clinical and experimental animal studies suggest that peripheral airways diseases may be due to the cumulative effects of recurrent respiratory infections over an extended period.
C. pneumoniae-specific IgG and IgA antibody levels were determined in two elderly groups of male patients with COPD and in control subjects without the disease. The first group (N = 36) consisted of patients who were hospitalized due to an acute exacerbation of COPD. The second group of patients (N = 54) and the controls (N = 321) were participants in a community survey on respiratory diseases in the elderly. The criteria for seropositivity were defined as an IgG titre of >=16.
89% of the hospitalized patients (group I) and 66% of the non-hospitalized patients (Group II) were IgA seropositive as compared to 55% of the controls. Derived from the logistic regression analysis, the odds ratio (OR) WAS 7.4 (95% CI : 2.1-25.7) between group I and the controls and 1.5 (0.7-2.9) between group II and controls. Furthermore, the difference in the age-adjusted geometric mean titres (GMT) of lgA antibodies between the group I and the controls was significant (53.0 for the patients versus 19.1 for the controls). On the contrary, no significant differences between the patients and the controls were found either in the proportion of IgG-seropositive or in the GMT of IgG antibodies. Two of the 29 patients with an exacerbation of COPD, for whom paired sera were available, showed an antibody response suggesting a current acute or reactivated chlamydial infection.
The results showed that C. pneumoniae lgA antibodies are found more frequently and in higher concentrations in COPD patients than in disease-free controls. The finding may indicate a chronic C. pneumoniae infection in these patients. The association persisted after controlling for the potential confounding effect of smoking.
成人期持续性或复发性呼吸道感染对慢性阻塞性肺疾病（COPD）发生发展的意义在很大程度上仍不明确。一些临床和实验动物研究表明，外周气道疾病可能是长期反复呼吸道感染的累积效应所致。
测定了两组老年男性COPD患者及无此病的对照者中肺炎衣原体特异性IgG和IgA抗体水平。第一组（N = 36）由因COPD急性加重而住院的患者组成。第二组患者（N = 54）和对照组（N = 321）是一项老年呼吸道疾病社区调查的参与者。血清学阳性标准定义为IgG滴度≥16。
与55%的对照组相比，89%的住院患者（第一组）和66%的非住院患者（第二组）IgA血清学阳性。根据逻辑回归分析，第一组与对照组之间的比值比（OR）为7.4（95%可信区间：2.1 - 25.7），第二组与对照组之间为1.5（0.7 - 2.9）。此外，第一组与对照组之间经年龄调整的IgA抗体几何平均滴度（GMT）差异显著（患者为53.0，对照组为19.1）。相反，患者与对照组在IgG血清学阳性比例或IgG抗体GMT方面均未发现显著差异。在29例有COPD加重且有配对血清的患者中，有2例显示出抗体反应，提示当前存在急性或再激活的衣原体感染。
结果表明，COPD患者中肺炎衣原体IgA抗体的发现频率和浓度高于无病对照组。这一发现可能表明这些患者存在慢性肺炎衣原体感染。在控制了吸烟的潜在混杂效应后，这种关联仍然存在。
