The innate and adaptive immune system is involved in the airway inflammation associated with acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). We evaluated the association of mannose-binding lectin (MBL), immunoglobulin (Ig) and ficolin-2 concentrations with COPD exacerbations and according to the glucocorticoid treatment duration for an index exacerbation. Post-hoc analysis of the randomized, double-blind, placebo-controlled REDUCE trial of 5 vs. 14 days of glucocorticoid treatment for an index exacerbation. MBL, ficolin-2 and total IgG/IgA and subclass concentrations were determined in stored samples drawn (n = 178) 30 days after the index exacerbation and associated with the risk of re-exacerbation during a 180-day follow-up period. IgG and subclass concentrations were significantly lower after 14 days vs. 5 days of glucocorticoid treatment. Patients with higher MBL concentrations were more likely to suffer from a future exacerbation (multivariable hazard ratio 1.03 per 200 ng/ml increase (95% confidence interval (CI) 1.00–1.06), p = 0.048), whereas ficolin-2 and IgG deficiency were not associated. The risk was most pronounced in patients with high MBL concentrations, IgG deficiency and 14 days of glucocorticoid treatment pointing towards an interactive effect of MBL and IgG deficiency in the presence of prolonged glucocorticoid treatment duration [Relative excess risk due to interaction 2.13 (95% CI − 0.41–4.66, p = 0.10)]. IgG concentrations were significantly lower in patients with frequent re-exacerbations (IgG, 7.81 g/L vs. 9.53 g/L, p = 0.03). MBL modified the short-term exacerbation risk after a recent acute exacerbation of COPD, particularly in the setting of concurrent IgG deficiency and recent prolonged systemic glucocorticoid treatment. Ficolin-2 did not emerge as a predictor of a future exacerbation risk.

中文翻译：

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甘露糖结合凝集素、ficolin-2 和免疫球蛋白浓度与慢性阻塞性肺疾病患者未来病情恶化的关联：随机对照 REDUCE 试验的二次分析


先天性和适应性免疫系统参与与慢性阻塞性肺病（COPD）患者急性加重相关的气道炎症。我们评估了甘露糖结合凝集素 (MBL)、免疫球蛋白 (Ig) 和 ficolin-2 浓度与 COPD 恶化之间的关系，并根据糖皮质激素治疗持续时间来评估恶化指数。对为期 5 天与 14 天的糖皮质激素治疗指数恶化的随机、双盲、安慰剂对照 REDUCE 试验进行事后分析。 MBL、ficolin-2 和总 IgG/IgA 和亚类浓度是在指数恶化后 30 天抽取的储存样本 (n = 178) 中测定的，并与 180 天随访期间再次恶化的风险相关。与糖皮质激素治疗 5 天后相比，14 天后 IgG 和亚类浓度显着降低。 MBL 浓度较高的患者未来病情加重的可能性更大（每增加 200 ng/ml，多变量风险比为 1.03（95% 置信区间 (CI) 1.00–1.06），p = 0.048），而 ficolin-2 和 IgG 缺乏没有关联。在 MBL 浓度高、IgG 缺乏和糖皮质激素治疗 14 天的患者中，该风险最为明显，这表明在糖皮质激素治疗持续时间延长的情况下，MBL 和 IgG 缺乏会产生相互作用[由于相互作用导致的相对过度风险 2.13 (95% CI) − 0.41–4.66，p = 0.10)]。频繁复发的患者的 IgG 浓度显着较低（IgG，7.81 g/L vs. 9.53 g/L，p = 0.03）。 MBL 改变了 COPD 最近急性恶化后的短期恶化风险，特别是在并发 IgG 缺乏和最近长期全身性糖皮质激素治疗的情况下。 Ficolin-2 并未成为未来病情恶化风险的预测因子。