慢性阻塞性肺疾病急性加重期感染呼吸道病毒与炎症因子的相关性分析

Correlation analysis between respiratory virus infection and inflammatory factors in the acute exacerbation of chronic obstructive pulmonary disease

目的检测慢性阻塞性肺疾病急性加重期(AECOPD)感染呼吸道病毒类型和外周血中炎症因子的水平,并分析两者之间可能存在的相关性。方法收集2016年10月至2018年10月在我院呼吸内科接受治疗的AECOPD患者154例,病毒阳性组40例(26.0%),病毒阴性组114例(74.0%);ELISA实验检测患者外周血中白介素-6(IL-6)、IL-8、干扰素诱导蛋白-10(IP-10)、活化T细胞趋化因子(RANTES)、IL-2R、肿瘤坏死因子-α(TNF-α)、干扰素-γ和c-反应蛋白的水平;单因素和多因素回归分析影响AECOPD感染呼吸道病毒的相关因素。结果病毒阳性组中鼻病毒所占比例最高17例(42.5%)。两组患者发热、糖尿病、CAT评分和CD8^+细胞比例之间差异有统计学意义(P<0.05);病毒阳性组IP-10、c-反应蛋白水平和TNF-α水平显著高于病毒阴性患者(P<0.05);发热、稳定期CAT评分、CD8^+细胞比例、IP-10和TNF-α为AECOPD病毒感染的相关因素。结论 AECOPD鼻病毒的检出率最高,发热、CAT评分≥20分、CD8^+细胞比例≤19%、IP-10>46.45ng/L和TNF-α>32.45ng/L组成的判别模型,对提示性AECOPD呼吸道病毒感染具有一定临床意义。

Objective To detect the type of respiratory virus and the levels of inflammatory factors in peripheral blood of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to analyze their possible correlation.Methods A total of 154 patients with AECOPD who were treated in the Department of Respiratory Medicine of our hospital from October 2016 to October 2018 were collected,40 in the virus positive group(26.0%),and 114 in the virus negative group(74.0%).It used ELISA test to detect IL-6,IL-8,IP-10,activated T cell chemokine(RANTES),IL-2 R,TNF-α,interferon-γand C-reactive protein.Univariate and multivariate regression analysis was used to analyze the factors influencing respiratory virus infection in AECOPD patients.Results The highest proportion of rhino viruses in the virus-positive group was 17(42.5%).There were statistically significant differences in fever,diabetes,CAT score,and CD8^+ cell ratio between the two groups(P<0.05).The levels of IP-10,C-reactive protein and TNF-α in the virus-positive group were significantly higher than those in virus-negative patients(P<0.05).Fever,CAT≥20 score,CD8^+ cell ratio≤19%,IP-10>46.45 ng/L and TNF-α>32.45 ng/L were related risk factors of AECOPD virus infection.Conclusion The discriminative model consisting of fever,stable CAT score,CD+8 cell ratio,IP-10 and TNF-α has certain clinical significance for suggesting AECOPD of respiratory virus infection.