在中国，鼻病毒与严重的成人社区获得性肺炎有关。
Rhinovirus is associated with severe adult community-acquired pneumonia in China.
作者信息
Wang Keqiang, Xi Wen, Yang Donghong, Zheng Yali, Zhang Yaqiong, Chen Yusheng, Yan Chunliang, Tian Guizhen, An Shuchang, Li Xiangxin, An Fucheng, Du Juan, Hu Ke, Cao Jie, Ren Lili, Huang Fang, Gao Zhancheng
机构信息
Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
Department of Respiratory and Critical Care Medicine, Peking University International Hospital, Beijing 102206, China.
出版信息
J Thorac Dis. 2017 Nov;9(11):4502-4511. doi: 10.21037/jtd.2017.10.107.
BACKGROUND
Human rhinovirus (HRV) is one of the most common viral etiologies detected in community-acquired pneumonia (CAP) adult cases. However, few is known about the characteristics of HRV-associated CAP. To describe the clinical features of HRV-associated CAP in immunocompetent adults admitted to multiple medical centers in mainland China over a 2-year period.
METHODS
A total of 383 patients admitted to hospitals for CAP were enrolled from 46 medical centers in mainland China between January 2013 and December 2014. Multiplex real-time polymerase chain reaction (RT-PCR) assays for viral detection and DNA-based quantitative loop-mediated isothermal amplification (qLAMP) assays for bacterial detection were implemented to all lower respiratory tract specimens obtained from the patients. Twenty-eight cases (28/383, 7.3%) revealed HRV-positive PCR results. Patients with bronchoalveolar lavage (BAL) HRV-positive PCR results (n=20) were further enrolled and divided into two groups depending on the status of bacterial co-infection (viral group, n=12; viral-Bacterial group, n=8). Demographic, clinical and microbiological data were reviewed and compared in detail.
RESULTS
Cases with HRV-infection were remarkably correlated with respiratory failure (14/20) and most of them (13/14) received mechanical ventilation. Fever (17/20), productive cough (15/20) and dyspnea (6/20) were common symptoms while flu-like symptoms were rarely observed in the cohort. (3/8), (3/8) and (2/8) were most frequently identified bacterium in the viral-bacterial group. Compared with the viral group, higher incidence of septic shock (3/8 1/12, P=0.255), longer ICU length of stay (LOS) (10.0 6.5 days, P=0.686), longer hospital LOS (18.5 13.0 days, P=0.208) and higher 28-day mortality (2/8 2/12, P=1) were observed in the Viral-Bacterial group, although without statistically significant difference.
CONCLUSIONS
HRV is a common etiology in CAP among China adults, especially in severe CAP. Clinicians should be vigilant considering of the poor outcome. Highly qualified multiplex PCR techniques with invasive sampling are needed to increase the detection rate.
背景
人鼻病毒（HRV）是社区获得性肺炎（CAP）成年病例中最常见的病毒病原体之一。然而，关于HRV相关CAP的特征知之甚少。本研究旨在描述中国大陆多个医疗中心收治的免疫功能正常的成年人中HRV相关CAP的临床特征，研究为期2年。
方法
2013年1月至2014年12月期间，从中国大陆46个医疗中心共纳入383例因CAP入院的患者。对所有患者的下呼吸道标本进行病毒检测的多重实时聚合酶链反应（RT-PCR）分析和细菌检测的基于DNA的定量环介导等温扩增（qLAMP）分析。28例（28/383，7.3%）患者的PCR结果显示HRV阳性。对支气管肺泡灌洗（BAL）HRV-PCR结果阳性的患者（n=20）进一步纳入研究，并根据细菌合并感染情况分为两组（病毒组，n=12；病毒-细菌组，n=8）。详细回顾并比较了人口统计学、临床和微生物学数据。
结果
HRV感染病例与呼吸衰竭显著相关（14/20），其中大多数（13/14）接受了机械通气。发热（17/20）、咳痰（15/20）和呼吸困难（6/20）是常见症状，而该队列中很少观察到流感样症状。病毒-细菌组中最常鉴定出的细菌为（3/8）、（3/8）和（2/8）。与病毒组相比，病毒-细菌组中感染性休克的发生率更高（3/8 对1/12，P=0.255），ICU住院时间更长（10.0对6.5天，P=0.686），住院时间更长（18.5对13.0天，P=0.208），28天死亡率更高（2/8对2/12，P=1），尽管差异无统计学意义。
结论
HRV是中国成年人CAP的常见病因，尤其是在重症CAP中。临床医生应警惕其不良预后。需要采用侵入性采样的高质量多重PCR技术来提高检测率。
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