【摘要】 目的 探讨一般人群中致癌性与非致癌性病原体的多重感染现状，分析其共性易感人群特征，并初步探索其与代谢和免疫指标的关联。方法 基于英国生物样本库队列，选取基线接受9种致癌性和11种非致癌性病原体血清抗原检测的9 429名参与者为研究对象。将感染同类病原体≥2种定义为联合感染，将感染种类超过人群中位值定义为多重感染。采用多因素logistic回归分析多重感染的独立影响因素；采用多元线性回归模型，调整性别、收入、教育、吸烟及饮酒等协变量后，分析多重感染与糖脂代谢及系统性免疫炎症指标的关联。结果 致癌性和非致癌性病原体的联合感染率分别为39.9%(3 763/9 429)和99.9%(9 415/9 429),多重感染率分别为39.9%(3 763/9 429)和35.2%(3 315/9 429)。多因素分析显示，较低家庭年收入(致癌性感染：最高收入组vs最低收入组，OR=0.75,95%CI:0.66～0.87;非致癌性感染：31 000～51 999英镑/年vs≤18 000英镑/年，OR=0.80,95%CI:0.70～0.92)、较低教育水平(致癌性感染：最低学历组vs最高学历组，OR=1.31,95%CI:1.15～1.49;非致癌性感染：中等教育证书/其他vs大学及以上，OR=1.17,95%CI:1.02～1.33)和吸烟(当前吸烟vs从不吸烟；致癌性感染OR=1.53,95%CI:1.33～1.76,非致癌性感染OR=1.33,95%CI:1.15～1.54)是2类感染的共同强危险因素。此外，肥胖(vs正常体质量，OR=1.31,95%CI:1.16～1.46)是非致癌性感染的特有危险因素。在生物标志物层面，致癌性病原体多重感染与较高的糖化血红蛋白(36.41 vs 35.72 mmol/mol,P=0.026)及甘油三酯(1.74 vs 1.73 mmol/L,P=0.023)水平相关，而与较低的总胆固醇(5.66 vs 5.74 mmol/L,P=0.011)及TyG指数(4.70 vs 4.70,P=0.013)相关；非致癌性病原体多重感染则与较高的糖化血红蛋白(36.40 vs 35.78 mmol/mol,P<0.001)及较低的高密度脂蛋白胆固醇(1.43 vs 1.46 mmol/L,P=0.002)相关。致癌性病原体多重感染与血小板/淋巴细胞比值降低相关(139.95 vs 147.06,P=0.004)。结论 一般人群中致癌性与非致癌性病原体的多重感染普遍存在，其易感性与较低的社会经济水平和不良生活方式密切相关。2类多重感染表现出差异性的糖脂代谢-免疫炎症特征谱，提示未来防控需整合社会干预与生物学策略。更多还原

【Abstract】 Objective To investigate the current status of multiple infections with carcinogenic and non-carcinogenic pathogens in the general population, and analyze the common characteristics of susceptible populations, preliminarily explore their risk factors and associations with metabolic and immunological features. Methods Based on the UK Biobank cohort, we included 9 429 participants who underwent baseline serological testing for 9 carcinogenic and 11 non-carcinogenic pathogens. Co-infection was defined as infection with ≥2 types of pathogen of the same type, while multiple infection were defined as the number of pathogen types exceeding the median value of infection in the population. Multivariable logistic regression analysis was employed to analyze the independent risk factors of multiple infections. Multiple linear models were used to analyze associations between multiple infections and glycolipid metabolic as well as systemic immune-inflammatory indices after adjusting for covariates including gender, income, education, smoking, and alcohol consumption. Results The co-infection rates for carcinogenic and non-carcinogenic pathogens were 39.9%(3 763/9 429) and 99.9%(9 415/9 429), respectively, while the multiple infection rates of 39.9%(3 763/9 429) and 35.2%(3 315/9 429), respectively. Multivariate analysis showed that lower annual household income(for carcinogenic infections: highest income group vs lowest, OR=0.75, 95%CI: 0.66-0.87; for non-carcinogenic infections: ￡31 000-51 999/year vs ≤￡18 000/year, OR=0.80, 95%CI: 0.70-0.92), lower educational attainment(for carcinogenic infections: lowest education level vs highest, OR=1.31, 95%CI: 1.15-1.49; for non-carcinogenic infections: CSEs/other vs university or above, OR=1.17, 95%CI: 1.02-1.33), and smoking(current smoking vs never smoking; for carcinogenic infections OR=1.53, 95%CI: 1.33-1.76; for non-carcinogenic infections OR=1.33, 95%CI: 1.15-1.54) were strong common risk factors for both types of infections. In addition, obesity(vs normal weight, OR=1.31, 95%CI: 1.16-1.46) was a specific risk factor for non-carcinogenic infections. At the biomarker level, multiple infections with carcinogenic pathogen were associated with higher glycated hemoglobin(36.41 vs 35.72 mmol/mol, P=0.026) and triglycerides(1.74 vs 1.73 mmol/L, P=0.023), but lower total cholesterol(5.66 vs 5.74 mmol/L, P=0.011) and TyG index(4.70 vs 4.70, P=0.013). Multiple infections with non-carcinogenic pathogens were associated with higher glycated hemoglobin(36.40 vs 35.78 mmol/mol, P<0.001) and lower high-density lipoprotein cholesterol(1.43 vs 1.46 mmol/L, P=0.002). Furthermore, multiple carcinogenic pathogen infections were correlated with a decreased platelet-to-lymphocyte ratio(139.95 vs 147.06, P=0.004). Conclusions Multiple infections are prevalent in the general population for both carcinogenic and non-carcinogenic pathogens, with higher susceptibility observed in populations with lower socioeconomic status and unhealthy lifestyles. The two types of multiple infections exhibit distinct profiles of glycolipid metabolism and immune inflammation, suggesting that future prevention and control strategies need to integrate social interventions with biological strategies.更多还原