Wat Dennis, Gelder Colin, Hibbitts Sam, Cafferty Fay, Bowler Ian, Pierrepoint Marcus, Evans Rachel, Doull Iolo
Department of Cystic Fibrosis, University Hospital of Wales, Cardiff, UK.
Llandough Hospital, Penarth, UK.
J Cyst Fibros. 2008 Jul;7(4):320-328. doi: 10.1016/j.jcf.2007.12.002. Epub 2008 Feb 6.
Previous studies have suggested a role played by respiratory viruses in the exacerbation of cystic fibrosis (CF). However, the impact of respiratory viruses could have been underestimated because of the low detection rate by conventional laboratory methods.
Children with CF had nasal swabs and sputum samples obtained on a routine basis and when they developed respiratory exacerbations. Nucleic Acid Sequence Based Amplification (NASBA) was used to detect respiratory viruses from nasal swabs. The definition of a respiratory exacerbation was when the symptom score totalled to 4 or more, or if the peak expiratory flow fell by more than 50 l/min from the child's usual best value, or if the parent subjectively felt that the child was developing a cold.
71 patients had 165 reported episodes of respiratory exacerbations. 138 exacerbation samples were obtained of which 63 (46%) were positive for respiratory viruses. In contrast, 23 of 136 asymptomatic nasal swabs (16.9%) were positive for respiratory viruses. There was significantly more viruses being detected during respiratory exacerbations, in particular influenza A, influenza B and rhinovirus (p<0.05). Upper respiratory symptoms significantly correlated with positive respiratory viral detection (p<0.05). This study also showed that viral respiratory exacerbations in CF could be independent from bacterial infections.
Respiratory viruses are associated with exacerbations in CF and upper respiratory symptoms are strong predictors for their presence. 'Real-time' NASBA has a rapid turn-around time and has the potential to aid clinical decision making, such as the use of anti-virals and administration of antibiotics.
先前的研究表明呼吸道病毒在囊性纤维化（CF）病情加重中发挥了作用。然而，由于传统实验室方法的检测率较低，呼吸道病毒的影响可能被低估了。
患有CF的儿童在常规情况下以及出现呼吸道病情加重时采集鼻拭子和痰液样本。基于核酸序列扩增（NASBA）技术用于检测鼻拭子中的呼吸道病毒。呼吸道病情加重的定义为症状评分总计达到4分或更高，或者呼气峰值流速比儿童通常的最佳值下降超过50升/分钟，或者家长主观感觉孩子正在患感冒。
71名患者报告了165次呼吸道病情加重发作。共获得138份病情加重样本，其中63份（46%）呼吸道病毒检测呈阳性。相比之下，136份无症状鼻拭子中有23份（16.9%）呼吸道病毒检测呈阳性。在呼吸道病情加重期间检测到的病毒明显更多，尤其是甲型流感病毒、乙型流感病毒和鼻病毒（p<0.05）。上呼吸道症状与呼吸道病毒检测呈阳性显著相关（p<0.05）。这项研究还表明，CF中的病毒性呼吸道病情加重可能与细菌感染无关。
呼吸道病毒与CF病情加重相关，上呼吸道症状是其存在的有力预测指标。“实时”NASBA检测周转时间快，有潜力辅助临床决策，如使用抗病毒药物和使用抗生素。
