慢性阻塞性肺疾病急性加重期呼吸道病毒感染检出率及危险因素分析

Prevalence and risk factors of respiratory viral infection in acute exacerbation of chronic obstructive pulmonary disease

目的探讨病毒感染与慢性阻塞性肺疾病（慢阻肺）急性加重期的关系及其危险因素。方法前瞻性纳入2014年6月至2016年6月北京安贞医院呼吸内科因慢阻肺急性加重住院的患者80例为急性加重组，其中男57例，女23例，年龄49～92岁，平均（75±8）岁，同期招募50例稳定期慢阻肺患者为对照组，其中男33例，女17例，年龄42-85岁，平均（75±10）岁。收集所有患者鼻咽拭子，通过PCR法检测18种呼吸道病毒感染率。结果急性加重组患者PCR病毒检测阳性18例（22．5％，18／80），其中鼻病毒检测阳性率最高（33％，6／18），其他依次为冠状病毒5例、副流感病毒4例、偏肺病毒2例和乙型流感1例。对照组病毒检测阳性4例，依次为流感病毒2例，鼻病毒1例，偏肺病毒1例。多因素回归分析结果表明，发热与慢阻肺急性加重患者病毒检出率密切相关（P〈0．01）。结论慢阻肺急性加重期更易检测到病毒感染，病毒感染是诱导慢阻肺急性加重的重要原因。鼻病毒是最常见的病原体。发热与慢阻肺急性加重患者病毒检出率密切相关。

Objective To study the prevalence of respiratory viral infection in chronic obstructive pulmonary disease （COPD） exacerbations and to find the factors associated with susceptibility to viral infections. Methods Eighty patients with exacerbations of COPD and 50 stable COPD patients were recruited. Nasopharyngeal swabs were tested for a range of 18 different respiratory viruses using PCR. Results Among the COPD exacerbations, viral infection was detected in 18 episodes （22. 5% ） . The most common virus was rhinovirus （ 33.3% ） , followed by coronavirus （ 27.8% ） , parainfluenza （ 22.2% ） , metapneumovirus（ 11.1% ） and influenza virus B（5.6% ）. The prevalence of viral infection was 8% in the stable COPD patients. In multivariate regression analysis fever was found to be significantly associated with viral infections in COPD exacerbations （ Odds ratio 4. 99, 95% CI 1.51 - 16. 48, P = 0. 008）. Conclusion Viral respiratory pathogens were more often detected in respiratory specimens from hospitalized patients with AECOPD than those with stable COPD. Rhinovirus was the most common infecting agent identified. The symptom of fever was associated with viral detection.