Hutchinson Anastasia F, Ghimire Anil K, Thompson Michelle A, Black Jim F, Brand Caroline A, Lowe Adrian J, Smallwood David M, Vlahos Ross, Bozinovski Steven, Brown Graham V, Anderson Gary P, Irving Louis B
Department of Respiratory Medicine, Melbourne Health, Victoria 3050, Australia.
Respir Med. 2007 Dec;101(12):2472-81. doi: 10.1016/j.rmed.2007.07.015. Epub 2007 Sep 5.
Respiratory viruses are associated with severe acute exacerbations of chronic obstructive pulmonary disease (COPD) in hospitalized patients. However, exacerbations are increasingly managed in the community, where the role of viruses is unclear. In community exacerbations, the causal association between viruses and exacerbation maybe confounded by random fluctuations in the prevalence of circulating respiratory viruses. Therefore, to determine whether viral respiratory tract infections are causally associated with community exacerbations, a time-matched case-control study was performed. Ninety-two subjects (mean age 72 yrs), with moderate to severe COPD, (mean FEV(1) 40% predicted), were enrolled. Nasopharyngeal swabs for viral multiplex polymerase chain reaction and atypical pneumonia serology were obtained at exacerbation onset. Control samples were collected in synchrony, from a randomly selected stable patient drawn from the same cohort. In 99 weeks of surveillance, there were 148 exacerbations. Odds of viral isolation were 11 times higher in cases, than their time-matched controls (34 discordant case-control pairs; in 31 pairs only the case had virus and in three pairs only control). Picornavirus (26), influenza A (3), parainfluenza 1,2,3 (2), respiratory syncytial virus (1), and adenovirus (1) were detected in cases while adenovirus (1) and picornavirus (2) were detected in controls. In patients with moderate or severe COPD the presence of a virus in upper airway secretions is strongly associated with the development of COPD exacerbations. These data support the causative role of viruses in triggering COPD exacerbations in the community.
呼吸道病毒与住院患者慢性阻塞性肺疾病（COPD）的严重急性加重相关。然而，目前在社区中对急性加重的管理越来越多，而病毒在其中的作用尚不清楚。在社区急性加重中，病毒与急性加重之间的因果关系可能会被流行的呼吸道病毒患病率的随机波动所混淆。因此，为了确定病毒性呼吸道感染是否与社区急性加重存在因果关系，我们进行了一项时间匹配的病例对照研究。我们纳入了92名患有中度至重度COPD（平均FEV(1)为预计值的40%）的受试者（平均年龄72岁）。在急性加重发作时采集鼻咽拭子进行病毒多重聚合酶链反应和非典型肺炎血清学检测。对照样本从同一队列中随机选择的病情稳定的患者中同步采集。在99周的监测期内，共发生148次急性加重。病例组病毒分离的几率比与其时间匹配的对照组高11倍（34对病例对照不匹配；31对中仅病例组检测到病毒，3对中仅对照组检测到病毒）。病例组检测到肠道病毒（26例）、甲型流感病毒（3例）、副流感病毒1、2、3型（2例）、呼吸道合胞病毒（1例）和腺病毒（1例），而对照组检测到腺病毒（1例）和肠道病毒（2例）。在患有中度或重度COPD的患者中，上呼吸道分泌物中存在病毒与COPD急性加重的发生密切相关。这些数据支持病毒在引发社区COPD急性加重中起致病作用。
