呼吸道合胞病毒感染对慢性阻塞性肺疾病急性加重期患者的影响

Influence of respiratory syntical virus infection on acute exacerbation of chronic obstructive pulmonary disease

目的:分析慢性阻塞性肺疾病急性加重(AECOPD)患者有无合并呼吸道合胞病毒(RSV)感染的临床资料,观察RSV感染的临床表现及其对AECOPD患者病情的影响。方法:2009年1月至6月瑞金医院呼吸科急诊留院观察符合AECOPD诊断标准病例80例,采用直接免疫荧光及酶联免疫吸附试验双重方法进行RSV感染定性检测,纳入阳性组12例,阴性组45例,比较两组间血浆和痰上清液肿瘤坏死因子α(TNF-α)水平、入院48h内入住ICU比率等临床资料。结果:①RSV阳性组和RSV阴性组AECOPD患者男女构成比、年龄、体质量指数(BMI)、第1秒用力呼气容积(FEV1)/用力肺活量(FVC)、FEV1占预计值(%)、吸烟史、本次就诊前1年慢性阻塞性肺疾病急性加重频率、本次加重天数无统计学意义(P均>0.05)。入院后首次血常规各类细胞计数、动脉血pH值、动脉血二氧化碳分压(PaCO2)、血TNF-α、痰上清液TNF-α在两组间差异无统计学意义(均P>0.05)。②12例RSV阳性组48h内入住ICU有5例,45例RSV阴性组入住ICU有6例,RSV阳性组较RSV阴性组入住ICU比率较高(P=0.03)。相关性分析示RSV阳性组痰上清液TNF-α与血清TNF-α呈正相关(r=0.66,P=0.02),RSV阴性组两指标无显著相关(P>0.05)。结论:合并RSV感染的AECOPD患者发病初期气道与全身炎症应答相关联可能是RSV感染的表现,合并RSV感染的患者入院48h内入住ICU的比率较高,提示RSV感染有导致AECOPD急性危重倾向。

Objective By comparing the clinical data from AECOPD patients with and without RSV infection to analyze the clinical characteristics and influence of RSV infection on the course of disease. Methods AECOPD patients admitted in emergency department of Ruijin Hospital from Jan 2009 to June 2009 were examined by direct fluorescence assay and enzyme-linked immunosorbent assay to detect the presence of RSV infection. Twelve patients were categorized to RSV positive group and 45 were to RSV negative group. Clinical data such as plasma and sputum supernatant TNF-α levels, and the ratio of ICU admission were compared between the two groups. Results No statistical difference was noted in sex ratio, age and body mass index between RSV positive and RSV negative groups （P0.05）. The clinical data including FEV1/ FVC, FEV1 % predicted, smoking history, frequency of acute exacerbation, and days of present exacerbation were not different significantly between the two groups （P0.05）. Also, no significant difference was found in blood cells count, PaCO2, pH, plasma and sputum supernatant TNF-α level between the two groups. The percentage of ICU admission within 48 hours was higher in RSV positive group than in RSV negative group（P=0.03）. In RSV positive group, the sputum supernatant TNF- α levelwas correlatedwith plasma TNF-α level （r=0.66, P=0.02）, and no significant correlation was found in RSV negative group （P0.05）. Conclusions The link between airway and systemic inflammatory response in early stage of AECOPD coexists with RSV infection may be a manifestation of RSV infection. ICU admission rate in RSV positive group is higher than that in RSV negative group, it denots that RSV infection has the tendency to aggravate the course of AECOPD patients.