感染在特发性肺纤维化急性加重中的作用。
The Role of Infection in Acute Exacerbation of Idiopathic Pulmonary Fibrosis.
机构信息
Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
School of Medicine, Suzhou University, Suzhou, China.
出版信息
Mediators Inflamm. 2019 Jan 3;2019:5160694. doi: 10.1155/2019/5160694. eCollection 2019.
BACKGROUND
Acute exacerbation of IPF (AE-IPF) is associated with high mortality. We studied changes in pathogen involvement during AE-IPF and explored a possible role of infection in AE-IPF.
OBJECTIVES
Our purpose is to investigate the role of infection in AE-IPF.
METHODS
Overall, we recruited 170 IPF patients (48 AE-IPF, 122 stable) and 70 controls at Shanghai Pulmonary Hospital. Specific IgM against microbial pathogens and pathogens in sputum were assessed. RNA sequences of pathogens in nasopharyngeal swab of IPF patients were detected by PathChip. A panel of serum parameters reflecting immune function were assessed.
RESULTS
Antiviral/bacterial IgM was higher in IPF vs. controls and in AE-IPF vs. stable IPF. Thirty-eight different bacterial strains were detected in IPF patient sputum. Bacteria-positive results were found in 9/48 (18.8%) of AE-IPF and in 26/122 (21.3%) stable IPF. Fifty-seven different viruses were detected in nasopharyngeal swabs of IPF patients. Virus-positive nasopharyngeal swabs were found in 18/30 (60%) of tested AE-IPF and in 13/30 (43.3%) of stable IPF. AE-IPF showed increased inflammatory cytokines (IL-6, IFN-, MIG, IL-17, and IL-9) vs. stable IPF and controls. Mortality of AE-IPF in one year (39.5%) was higher compared to stable IPF (28.7%). IPF patients had different colonization with pathogens in sputum and nasopharyngeal swabs; they also displayed abnormally activated immune response, which was exacerbated during AE-IPF.
背景
特发性肺纤维化（IPF）急性加重（AE-IPF）与高死亡率相关。我们研究了 AE-IPF 期间病原体参与的变化，并探讨了感染在 AE-IPF 中的可能作用。
目的
我们旨在研究感染在 AE-IPF 中的作用。
方法
我们共招募了 170 名 IPF 患者（48 名 AE-IPF，122 名稳定）和 70 名对照于上海肺科医院。评估了针对微生物病原体和痰液中病原体的特异性 IgM。通过 PathChip 检测了 IPF 患者鼻咽拭子中病原体的 RNA 序列。评估了反映免疫功能的一系列血清参数。
结果
与对照组和稳定型 IPF 相比，IPF 患者的抗病毒/细菌 IgM 更高。在 IPF 患者的痰中检测到 38 种不同的细菌菌株。在 9/48（18.8%）例 AE-IPF 和 26/122（21.3%）例稳定型 IPF 中发现细菌阳性结果。在 IPF 患者的鼻咽拭子中检测到 57 种不同的病毒。在 18/30（60%）例测试的 AE-IPF 和 13/30（43.3%）例稳定型 IPF 中发现病毒阳性鼻咽拭子。AE-IPF 患者的炎症细胞因子（IL-6、IFN-γ、MIG、IL-17 和 IL-9）水平高于稳定型 IPF 和对照组。AE-IPF 在一年内的死亡率（39.5%）高于稳定型 IPF（28.7%）。AE-IPF 患者的痰液和鼻咽拭子中存在不同的病原体定植；他们还表现出异常激活的免疫反应，在 AE-IPF 期间加剧。
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