Zhao C L, Huang J W, Zhang L, Zhang Q R, Li Q M, Zhou M
Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University; Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2018 Dec 12;41(12):942-948. doi: 10.3760/cma.j.issn.1001-0939.2018.12.009.
To investigate the characteristics of respiratory viral infections, and correlation between inflammatory cytokines and respiratory virus infections in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). A prospective cohort of patients with acute exacerbations of COPD was enrolled. The sputum of all patients were collected, and 15 respiratory viruses were detected using multi-channel real-time fluorescence quantitative PCR. The clinical characteristics associated with viral infections were analyzed. The peripheral blood of the patients was collected and cytokines including IL-6, IL-8, RANTES, IP-10, sIL-2R, IFN-γ, TNF-α in the serum were detected by ELISA. Association of these cytokines with respiratory viral infections was evaluated and a discriminant model was established. A total of 99 patients with acute exacerbations of COPD were enrolled in this study. Thirty-four cases (34.3%, 34/99) were positive for viral detection. Among them, the positive rate of influenza A virus was the highest (38.2%, 13/34), followed by rhinovirus (35.3%, 12/34). Multifactor logistic regression analysis showed that, fever, COPD assessment test (CAT) score in stable stage, serum IP-10 and TNF-α levels were correlated with respiratory viral infections in patients with acute exacerbations of COPD. The levels of serum IP-10 and sIL-2R increased significantly in patients with influenza A virus. Respiratory viral infections were common in acute exacerbations of COPD. Influenza A virus and rhinovirus were the two most common viruses. Fever was a common symptom. Patients with severe respiratory symptoms at stable stage were susceptible to viral infection. Viral infection was associated with an increase in systemic inflammatory levels, most significantly in influenza virus infection. A discriminant model composed of fever, CAT score in stable stage, serum IP-10 and TNF-α levels can be used to predict respiratory viral infections in acute exacerbations of COPD.
为研究慢性阻塞性肺疾病（COPD）急性加重期患者呼吸道病毒感染的特征以及炎性细胞因子与呼吸道病毒感染之间的相关性。纳入了一组COPD急性加重期患者的前瞻性队列。收集所有患者的痰液，采用多通道实时荧光定量PCR检测15种呼吸道病毒。分析与病毒感染相关的临床特征。采集患者外周血，采用酶联免疫吸附测定法检测血清中白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、调节活化正常T细胞表达和分泌的趋化因子（RANTES）、γ干扰素诱导蛋白10（IP-10）、可溶性白细胞介素-2受体（sIL-2R）、γ干扰素（IFN-γ）、肿瘤坏死因子-α（TNF-α）等细胞因子。评估这些细胞因子与呼吸道病毒感染的相关性并建立判别模型。本研究共纳入99例COPD急性加重期患者。34例（34.3%，34/99）病毒检测呈阳性。其中，甲型流感病毒阳性率最高（38.2%，13/34），其次是鼻病毒（35.3%，12/34）。多因素logistic回归分析显示，发热、稳定期慢性阻塞性肺疾病评估测试（CAT）评分、血清IP-10和TNF-α水平与COPD急性加重期患者呼吸道病毒感染相关。甲型流感病毒感染患者血清IP-10和sIL-2R水平显著升高。呼吸道病毒感染在COPD急性加重期很常见。甲型流感病毒和鼻病毒是两种最常见的病毒。发热是常见症状。稳定期有严重呼吸道症状的患者易发生病毒感染。病毒感染与全身炎症水平升高有关，在流感病毒感染中最为显著。由发热、稳定期CAT评分、血清IP-10和TNF-α水平组成的判别模型可用于预测COPD急性加重期的呼吸道病毒感染。
