Yormaz Burcu, Fındık Duygu, Süerdem Mecit
Department of Chest Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey.
Department of Medical Microbiology, Faculty of Medicine, Selcuk University, Konya, Turkey.
Tuberk Toraks. 2019 Jun;67(2):124-130. doi: 10.5578/tt.68471.
Exacerbations of chronic obstructive pulmonary disease (COPD) are often caused by respiratory tract infections. The aim of this study was to investigate the clinical, laboratory and computed tomography features of patients with hospitalized COPD exacerbations in which respiratory viruses were detected using a real-time polymerase chain reaction (PCR) technique.
This retrospectively planned study included patients hospitalized in the chest diseases clinic due to exacerbation of COPD between November 2018-February 2019. The study included patients who had virus-specific real-time PCR, and computed tomography scans of the chest.
A total of 110 patients were included in the study. Respiratory viruses were identified in the nasopharyngeal swabs of 50 patients (45.5%) using the real-time PCR method, with rhinovirus (25%), influenza A (13.1%) and coronavirus (11.8%) being the most commonly isolated agents. The mean age of the patients was 68.28 ± 9.59 years in the virus-positive group and 68.20 ± 8.27 years in the virus-negative group (p= 0.963). Gender distribution, rate of smokers, exposure to biofuels, blood leukocyte count, neutrophil percentage, C-reactive protein (CRP) level, FEV1/FVC ratio did not significantly differ between the two groups (p> 0.05). Procalcitonin (PCT) and FEV1 values were significantly lower (p= 0.001 and p= 0.028, respectively) and the number of exacerbations was significantly higher in the virus-positive group (p= 0.001). The length of hospital stay was longer in the virus-positive group than in the virus-negative group (p= 0.012). Among the findings of computed tomography (CT) of the chest, bronchial wall thickening, cystic bronchiectasis, and emphysema did not differ significantly (p> 0.05). The rate of infiltrative lesions (tree-in-bud opacity, ground-glass opacity, atypical pneumonia) was significantly higher in the virus-positive group (p= 0.020).
Viral respiratory tract infections should be considered in hospitalized patients with an exacerbation of COPD who have a history of frequent exacerbations, normal PCT value, and the absence of consolidation in CT scan of the chest. The use of broadspectrum antibiotic therapy should be avoided in patients with these features.
慢性阻塞性肺疾病（COPD）急性加重通常由呼吸道感染引起。本研究旨在调查因COPD急性加重住院且采用实时聚合酶链反应（PCR）技术检测出呼吸道病毒的患者的临床、实验室及计算机断层扫描特征。
本项回顾性研究纳入了2018年11月至2019年2月期间因COPD急性加重入住胸科门诊的患者。研究包括进行了病毒特异性实时PCR检测及胸部计算机断层扫描的患者。
本研究共纳入110例患者。采用实时PCR方法在50例患者（45.5%）的鼻咽拭子中检测到呼吸道病毒，其中鼻病毒（25%）、甲型流感病毒（13.1%）和冠状病毒（11.8%）是最常见的分离病原体。病毒阳性组患者的平均年龄为68.28±9.59岁，病毒阴性组为68.20±8.27岁（p = 0.963）。两组在性别分布、吸烟者比例、生物燃料暴露情况、血白细胞计数、中性粒细胞百分比、C反应蛋白（CRP）水平、FEV1/FVC比值方面无显著差异（p>0.05）。病毒阳性组的降钙素原（PCT）和FEV1值显著更低（分别为p = 0.001和p = 0.028），且急性加重次数显著更高（p = 0.001）。病毒阳性组的住院时间比病毒阴性组长（p = 0.012）。胸部计算机断层扫描（CT）结果中，支气管壁增厚、囊状支气管扩张和肺气肿无显著差异（p>0.05）。病毒阳性组的浸润性病变（树芽征、磨玻璃影、非典型肺炎）发生率显著更高（p = 0.020）。
对于有频繁急性加重病史、PCT值正常且胸部CT扫描无实变的COPD急性加重住院患者，应考虑病毒呼吸道感染。具有这些特征的患者应避免使用广谱抗生素治疗。
