Gao Yong-Hua, Guan Wei-Jie, Xu Gang, Lin Zhi-Ya, Tang Yan, Lin Zhi-Min, Gao Yang, Li Hui-Min, Zhong Nan-Shan, Zhang Guo-Jun, Chen Rong-Chang
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong.
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong.
Chest. 2015 Jun;147(6):1635-1643. doi: 10.1378/chest.14-1961.
Although viral infections are a major cause of exacerbations in patients with chronic airway diseases, their roles in triggering bronchiectasis exacerbations in adults remain unclear. Therefore, we prospectively investigated the incidence and clinical impacts of viral infection in adults with bronchiectasis exacerbations.
The study cohort of 119 adults with bronchiectasis was followed up prospectively for 12 months. Nasopharyngeal swabs and sputum samples were assayed for 16 respiratory viruses, using polymerase chain reaction assays. Symptoms, spirometry, quality of life, bacterial cultures, and inflammatory markers were assessed during steady-state bronchiectasis and exacerbations.
A total of 100 exacerbations were captured from 58 patients during 1-year follow-up. Respiratory viruses were found more frequently in nasopharyngeal swabs and sputum during bronchiectasis exacerbations (49 of 100, 49.0%) than during steady state (11 of 58, 18.9%; P < .001). The most common viruses found in patients experiencing exacerbations were coronavirus (19 of 65, 39.2%), rhinovirus (16 of 65, 24.6%), and influenza A/B viruses (16 of 65, 24.6%). Virus-positive exacerbations were associated with a greater increase in markers of systemic and airway inflammation (serum IL-6 and tumor necrosis factor-α; sputum IL-1β and tumor necrosis factor-α) compared with virus-negative exacerbations, but the differences in spirometric indexes, quality of life, and bacterial density were unremarkable. In receiver operating characteristics analysis, serum interferon-γ-induced protein 10 yielded an area under curve of 0.67 (95% CI, 0.53-0.77; P = .018). Furthermore, a greater proportion of patients with virus-positive exacerbations received IV antibiotics.
Prevalence of viral infections, detected by polymerase chain reaction assay, is higher in cases of bronchiectasis exacerbations than in steady-state bronchiectasis, suggesting that respiratory viruses play crucial roles in triggering bronchiectasis exacerbations. The potential mechanisms of virus-induced bronchiectasis exacerbations merit further investigations.
ClinicalTrials.gov; No.: NCT01801657; www.clinicaltrials.gov.
尽管病毒感染是慢性气道疾病患者病情加重的主要原因，但其在引发成人支气管扩张症病情加重中的作用仍不明确。因此，我们对成人支气管扩张症病情加重时病毒感染的发生率及临床影响进行了前瞻性研究。
对119例成人支气管扩张症患者组成的研究队列进行了为期12个月的前瞻性随访。采用聚合酶链反应分析法对鼻咽拭子和痰液样本进行16种呼吸道病毒检测。在支气管扩张症稳定期和病情加重期评估症状、肺功能、生活质量、细菌培养及炎症标志物。
在1年的随访期间，共58例患者出现100次病情加重。与稳定期（58例中的11例，18.9%；P<0.001）相比，支气管扩张症病情加重期在鼻咽拭子和痰液中更频繁地检测到呼吸道病毒（100例中的49例，49.0%）。病情加重患者中最常见的病毒为冠状病毒（65例中的19例，39.2%）、鼻病毒（65例中的16例，24.6%）和甲型/乙型流感病毒（65例中的16例，24.6%）。与病毒阴性的病情加重相比，病毒阳性的病情加重与全身及气道炎症标志物（血清白细胞介素-6和肿瘤坏死因子-α；痰液白细胞介素-1β和肿瘤坏死因子-α）的更大升高相关，但肺功能指标、生活质量和细菌密度的差异不显著。在受试者工作特征分析中，血清干扰素-γ诱导蛋白10的曲线下面积为0.67（95%CI，0.53-0.77；P = 0.018）。此外，病毒阳性病情加重的患者中接受静脉用抗生素治疗的比例更高。
通过聚合酶链反应分析法检测到的病毒感染在支气管扩张症病情加重病例中的发生率高于稳定期支气管扩张症，提示呼吸道病毒在引发支气管扩张症病情加重中起关键作用。病毒诱导支气管扩张症病情加重的潜在机制值得进一步研究。
ClinicalTrials.gov；编号：NCT01801657；网址：www.clinicaltrials.gov。
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