Esther Charles R, Lin Feng-Chang, Kerr Alan, Miller Melissa B, Gilligan Peter H
Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Pediatr Pulmonol. 2014 Sep;49(9):926-31. doi: 10.1002/ppul.22917. Epub 2013 Oct 25.
Test the hypothesis that the link between respiratory viruses and pulmonary exacerbation in cystic fibrosis (CF) reflects increased frequency or severity of lower airways infection.
Molecular respiratory viral panels (RVPs), cell counts, and quantitative bacterial cultures were assessed in 235 bronchoalveolar lavage fluid (BALF) samples from 138 children with CF. Relationships among the data were analyzed using multivariate methods.
RVPs were positive in 67 (28.5%) BALF samples from 52 (37.7%) patients, with rhinovirus/enterovirus most common (82.4% of RVP+). RVP+ patients were younger (5.4 years, IQR 3.0-9.7 vs. 8.0 years, IQR 3.5-12.9; P < 0.01), more likely to have respiratory symptoms (74.6% vs. 55.2%, P < 0.01), and had higher BALF percent neutrophils (70.5%, IQR 46-85% vs. 59.3%, IQR 34-77%; P < 0.05). Percent predicted FEV1 at bronchoscopy was diminished from baseline in both groups, but recovered in the RVP- (90.2 ± 22.2% vs. 89.6 ± 19.7%, P = 0.62) but not the RVP+ subjects (95.7 ± 21.1% vs. 89.1 ± 18.0%, P < 0.05). RVP status did not alter recovery rates of typical CF respiratory pathogens including Staphylococcus aureus (44.8% vs. 42.9%) and Pseudomonas aeruginosa (25.4% vs. 25.6%). However, common respiratory pathogens (Haemophilus species, Moraxella species, and Streptococcus pneumoniae) were recovered more frequently from RVP+ samples independent of age (OR 3.6, 95% CI 1.8-7.5, P < 0.001).
Respiratory viruses were frequently detected in BALF from CF patients and associated with markers of disease severity. Respiratory viruses did not impact frequency or severity of infection with typical CF pathogens, but rates of infection with common respiratory pathogens were increased. This finding may have treatment implications.
检验以下假设，即囊性纤维化（CF）患者中呼吸道病毒与肺部加重之间的联系反映了下呼吸道感染频率增加或严重程度加重。
对138例CF患儿的235份支气管肺泡灌洗液（BALF）样本进行了分子呼吸道病毒检测板（RVPs）、细胞计数和定量细菌培养。使用多变量方法分析数据之间的关系。
52例（37.7%）患者的67份（28.5%）BALF样本中RVPs呈阳性，其中鼻病毒/肠道病毒最为常见（占RVPs阳性样本的82.4%）。RVPs阳性患者更年幼（5.4岁，四分位间距3.0 - 9.7岁，而阴性患者为8.0岁，四分位间距3.5 - 12.9岁；P < 0.01），更易出现呼吸道症状（74.6% 对55.2%，P < 0.01），且BALF中性粒细胞百分比更高（70.5%，四分位间距46 - 85%，而阴性患者为59.3%，四分位间距34 - 77%；P < 0.05）。两组患者支气管镜检查时预计FEV1百分比均较基线下降，但RVPs阴性组恢复（90.2 ± 22.2% 对89.6 ± 19.7%，P = 0.62），而RVPs阳性组未恢复（95.7 ± 21.1% 对89.1 ± 18.0%，P < 0.05）。RVPs状态并未改变典型CF呼吸道病原体的恢复率，包括金黄色葡萄球菌（44.8% 对42.9%）和铜绿假单胞菌（25.4% 对25.6%）。然而，常见呼吸道病原体（嗜血杆菌属、莫拉克斯氏菌属和肺炎链球菌）在RVPs阳性样本中的检出频率更高，与年龄无关（比值比3.6，95%置信区间1.8 - 7.5，P < 0.001）。
在CF患者的BALF中经常检测到呼吸道病毒，且与疾病严重程度标志物相关。呼吸道病毒并未影响典型CF病原体的感染频率或严重程度，但常见呼吸道病原体的感染率增加。这一发现可能对治疗有启示意义。
