结缔组织病相关性间质性肺炎患者合并EB病毒感染炎症因子及DNA载量分析

Inflammatory factors and DNA load in patients with connective tissue disease-associated interstitial pneumonia combined with EB virus infection

目的探讨EB病毒感染对结缔组织病相关性间质性肺炎的影响。方法选取2017年12月-2019年12月天津市第五中心医院收治的结缔组织病相关性间质性肺炎患者190例的资料进行回顾性分析。依据患者是否发生EB病毒感染进行分析分组,感染组65例,未感染组125例。比较两组患者的临床资料、合并疾病情况及动脉血气分析结果、EB病毒检测情况、中性粒细胞百分比、治疗有效时间、转入重症监护室(ICU)比例。对比两组炎性相关指标[C-反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)、白细胞介素-6(IL-6)、IL-17、IL-33]。分析两组的EB病毒DNA含量与各类炎性相关指标的相关性。结果 EB病毒感染率为34.21%(65/190)。未感染组动脉氧分压为(61.92±18.25)mmHg高于感染组,革兰阴性菌感染占比、治疗有效时间和转入ICU占比分别为45.60%(57/125)、(7.61±2.75)d、13.60%(17/125)均低(短)于感染组(P<0.05)。两组的二氧化碳分压、中性粒细胞百分比差异无统计学意义。感染组的CRP、PCT、WBC、IL-6、IL-17、IL-33分别为(53.25±5.31)mg/L、(0.78±0.10)μg/L、(14.32±0.67)×109/L、(151.58±11.25)ng/L、(116.28±12.33)ng/L、(61.56±3.65)ng/L高于未感染组(P<0.001)。EB病毒DNA含量与CRP、PCT、WBC、IL-6、IL-17、IL-33均呈正相关(P<0.05)。结论 EB病毒感染可使结缔组织病相关性肺间质性肺炎患者的病情进一步恶化,在该种类患者的治疗过程中需特别注意。

OBJECTIVE To investigate the effect of Epstein Barr virus(EBV) infection on connective tissue disease associated interstitial pneumonia. METHODS The data of 190 patients with connective tissue disease-related interstitial pneumonia from Dec. 2017 to Dec. 2019 in the Tianjin Fifth Central Hospital were selected for retrospectively analysis, and were divided into 65 cases of infection group and 125 cases of non-infection group according to whether the patients had EB virus infection. The clinical data, comorbidities, arterial blood gas analysis results, detection of EB virus, percentage of neutrophils, effective time of treatment and proportion of patients transferred to intensive care unit(ICU) were compared between the two groups of patients. The inflammatory related indexes [C-reactive protein(CRP), procalcitonin(PCT), white blood cell count(WBC), interleukin-6(IL-6), interleukin-17(IL-17), interleukin-33(IL-33)] were compared between the two groups. The correlation between EBV DNA content and various inflammatory indexes were analyzed. RESULTS The infection rate of Epstein Barr virus was 34.21%(65/190). The arterial oxygen partial pressure in the non-infection group was(61.92±18.25) mmHg, significantly higher than that in the infection group(P<0.05). The proportion of Gram-negative bacteria infection, the effective time of treatment and the proportion of transferred to ICU were 45.60%(57/125),(7.61±2.75) D and 13.60%(17/125) respectively, significantly lower(shorter) than those in the infection group(P<0.05). There was no significant difference in partial pressure of carbon dioxide and percentage of neutrophils between the two groups. The levels of CRP, PCT, WBC, IL-6, IL-17 and IL-33 in the infection group were(53.25±5.31) mg/L,(0.78±0.10)μg/L,(14.32±0.67)×109/L,(151.58±11.25)ng/L,(116.28±12.33)ng/L and(61.56±3.65)ng/L, respectively, significantly higher than those in non-infection group(P<0.05). The Epstein Barr virus DNA content was positively correlated with CRP, PCT, WBC, IL-6, IL-17 and IL-33(P<0.001). CONCLUSION EBV infection can further worsen the condition of patients with connective tissue disease associated pulmonary interstitial pneumonia, which needs special attention in the treatment of this kind of patients.