营养状态和MASP-2基因多态性与COPD并发肺部感染的关联性

Association between nutrition status, MASP-2 gene polymorphisms and pulmonary infection in COPD patients

目的 分析慢性阻塞性肺疾病(COPD)患者肺部感染致病菌分布及营养状态、甘露糖结合凝集素(MBL)相关的丝氨酸蛋白酶-2(MASP-2)基因多态性。方法 选取2018年12月-2020年12月在四川省人民医院呼吸与危重症医学科住院治疗的159例COPD患者为研究对象,其中111例COPD继发社区获得性肺炎(CAP)患者经病原学检查确诊肺部感染,纳入感染组,其余48例非CAP患者纳入非感染组;分析感染组致病菌分布及药敏试验结果、营养状态、MASP-2基因多态性,Logistic回归分析COPD患者肺部感染与营养状态、MASP-2基因多态性的关系。结果 111例COPD继发肺部感染患者标本中检出病原菌123株,其中革兰阴性菌占61.79%,其次为革兰阳性菌占31.71%。两组肺炎严重度指数(PSI)分级、营养风险筛查(NRS2002)评分差异有统计学意义(P<0.05);两组MASP-2基因rs2273346位点基因型分布差异无统计学意义,但rs6695096位点基因多态性有统计学意义(P<0.05);Logistic回归分析显示PSI分级Ⅳ~Ⅴ级、NRS2002评分、rs6695096位点TC基因型均是COPD继发肺部感染的影响因素(P<0.05)。结论 COPD患者肺部感染的发生与PSI分级、营养状态及rs6695096位点基因多态性显著相关,值得临床重视。

OBJECTIVE To analyze the distribution of lung infection pathogens, nutrition status and polymorphisms of mannose binding lectin-associated serine protease(MASP-2) gene in patients with chronic obstructive pulmonary disease(COPD). METHODS Among 159 patients with COPD admitted to respiratory medicine department of the hospital from Dec 2018 to Dec 2020, 111 cases confirmed with lower respiratory tract infection by etiology were divided into the infection group and the remaining 48 COPD cases without pulmonary infection were in the COPD group. The distribution of pathogens, results of drug susceptibility tests, nutrition status, and polymorphisms of MASP-2 gene in the infection group were collected and analyzed. The relationship between pulmonary infection and nutrition status and polymorphisms of MASP-2 gene in COPD patients was analyzed by multivariate Logistic regression analysis. RESULTS Total of 123 strains of pathogens were detected in 111 patients with COPD, Gram-negative bacteria accounting for 61.79% and Gram-positive bacteria accounting for 31.71%. There were significant differences in grading of pneumonia severity index(PSI) and scores of Nutrition Risk Screening 2002(NRS2002) between the infection group and COPD group(P<0.05). The differences in the distribution of MASP-2 gene genotypes and alleles at rs2273346 locus and the distribution of MASP-2 gene alleles at rs6695096 locus between the two groups were not significant, while the difference in the distribution of MASP-2 gene genotypes at rs6695096 locus was significant(P<0.05). Multivariate Logistic regression analysis showed that PSI grading at grade IV-V, NRS2002 score and TC genotype at rs6695096 locus were the risk factors for pulmonary infection secondary to COPD. CONCLUSION The occurrence of pulmonary infection is significantly related to PSI grading, nutrition status and gene polymorphisms at rs6695096 locus in COPD patients.