慢性阻塞性肺疾病急性加重期患者病毒感染分析及对气道炎症的影响

Analysis of viral infection of chronic obstructive pulmonary disease and its effect on airway inflammation

目的探讨慢性阻塞性肺疾病(COPD)急性加重期患者的病毒感染情况及对气道炎症的影响。方法选择2015年3月-2016年3月医院收治的COPD患者130例为研究对象,分为急性加重期组80例和稳定期组50例。所有患者入院第1天清晨空腹采集静脉血,间接免疫荧光法检测血中呼吸道合胞病毒(RSV)、腺病毒(ADV)、副流感病毒(PIV)、甲型流感病毒(FLU-A)、乙型流感病毒(FLU-B)、单纯疱疹病毒(HSV)、巨细胞病毒(CMV)的免疫球蛋白M(IgM)、免疫球蛋白G(IgG)抗体。比较各组病毒感染总阳性率、IgM及IgG抗体检测的阳性率。根据IgM抗体检测结果将急性加重期组分为:IgM阳性患者28例和IgM阴性患者(52例)。酶联免疫吸附实验(ELISA)法检测两组患者诱导痰液中白细胞介素-8(IL-8)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、白细胞介素-10(IL-10)水平。结果急性加重期组病毒感染总阳性率、IgM检测阳性率、IgG检测阳性率分别为87.5%、35.0%、85.0%,均高于稳定期组的72.0%、14.0%、66.0%(P<0.05);急性加重期组RSV、HSV的IgM、IgG抗体检测阳性例数均高于稳定期组;IgM阳性患者痰液中IL-8、IL-6、TNF-α水平均高于IgM阴性患者,IL-2、IL-10水平均低于IgM阴性患者(P<0.05)。结论病毒感染与COPD急性加重关系密切,并可以导致气道炎症情况加重。

OBJECTIVE To explore the viral infection of chronic obstructive pulmonary disease（COPD）and its effect on airway inflammation.METHODS A total of 130 cases of COPD from Mar.2015 to Mar.2016 were selected and were divided into 80 cases with acute exacerbation period group（80 cases）and 50 stable periodic group（50 cases）.All patients were collected the venous blood at the first days after admission,and the indirect immunofluorescence method was used to detect the IgM and IgG antibodies of RSV,ADV,PIV,FLU-A,FLU-B,HSV,and CMV were detected by the indirect immunofluorescence method.The total positive rate,IgM and IgG antibody positive rates were compared.According to detection results of IgM antibody detection,the acute exacerbation period group was divided into：IgM positive group（28 cases）and IgM negative group（52 cases）.ELISA was used to detect the phlegm levels of IL-8,IL-6,TNF-α,IL-2,and IL-10 in these two groups.RESULTS The total positive rate of recombinant virus infection in the acute stage,the positive rate of IgM detection and the positive rate of IgG detection of the acute exacerbation group were 87.5%,35.0% and 85.0%.which were significantly higher than that 72.0%,14.0%and 66.0% of the stable group（87.5% vs 72.0%;35.0% vs 14.0%;85.0% vs 66.0%）（P〈0.05 or P〈0.01）.The positive rates of IgM and IgG antibody in the RSV,HSV and IgG in the acute exacerbation period group were significantly higher than that those in the stable group（21.25% vs 4.0%;11.25% vs 0%;57.5% vs 34.0%;17.5% vs 4.0%）（P〈0.05 or P〈0.01）.The levels of IL-8,IL-6,and TNF-αin the IgM positive group were significantly higher than thosethat in the IgM negative group[（36.65±3.21）vs（30.32±3.47）;（0.67±0.05）vs（0.51±0.07）;（12.32±1.47）vs（10.15±1.04）],and the levels of IL-2,and IL-10 were significantly lower than those in the IgM negative group[（1.48±0.12）vs（2.16±0.32）;（38.49±3.66）vs（54.52±5.67）]（P〈0.05）.CONCLUSION Virus infection is closely related to acute exacerbation of COPD and can lead to aggravation of airway inflammation.