AECOPD患者感染呼吸道病毒特征及呼吸道合胞病毒感染与血清IP-10的关系

The characteristics of a respiratory virus infection in patients with AECOPD and the relationship between respiratory syncytial virus infection and the expression of serum IP-10

目的研究慢性阻塞性肺疾病急性加重(AECOPD)患者感染呼吸道病毒特征,以及呼吸道合胞病毒感染与患者血清IP-10的关系。方法选择本院2019年1月-2020年10月收治的AECOPD患者125例,取咽试子标本,采用多重PCR的方法检查呼吸道病毒等的感染情况,采用肺功能检测仪检查患者的肺功能指标,ELISA的方法检测血清IP-10水平,比较不同肺功能分级AECOPD患者呼吸道合胞病毒检出情况以及IP-10水平。根据患者感染情况分为A组(仅感染呼吸道合胞病毒)、B组(呼吸道合胞病毒感染合并其他病毒感染)、C组(非呼吸道合胞病毒感染)、D组(未检测到病毒感染),比较4组患者血清炎性因子和IP-10水平及其与合胞病毒感染的关系。结果 125例AECOPD患者中67例(53.60%)检出呼吸道病毒感染,共检出病毒69株,主要为流感病毒A(占28.99%),呼吸道合胞病毒(占26.09%)和流感病毒B(占20.29%)。125例患者按肺功能分级,Ⅰ级21例,Ⅱ级42例,Ⅲ级51例,IV级11例。4组患者的呼吸道合胞病毒检出率、血清IP-10水平差异均有统计学意义(P<0.05或P<0.01),且随分级的增加呼吸道合胞病毒检出率和血清IP-10水平增高。Pearson相关分析显示,血清IP-10水平与FEV1值呈负相关性(r=-0.626,95%CI:-0.699~-0.539,P<0.01)。4组患者的血清炎性因子IL-1β、IL-8、IFN-γ、TNF-α和IP-10差异均有统计学意义(均P<0.01),其中A、B、C组血清炎性因子水平均显著高于D组,B组显著高于A、C组(均P<0.05)。呼吸道合胞病毒感染患者经治疗后血清IL-1β、IL-8、IFN-γ、TNF-α、IP-10水平均显著降低(均P<0.01)。结论 AECOPD患者感染的呼吸道病毒主要为流感病毒A、呼吸道合胞病毒和流感病毒B,其中呼吸道合胞病毒感染可通过诱导IP-10的表达加重疾病进展。

Objective To study the characteristics of a respiratory virus infection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and the relationship between respiratory syncytial virus infection and serum IP-10. Methods Subjects were 125 patients with AECOPD seen at this Hospital from January 2019 to October 2020. Pharyngeal specimens were collected, infection with the respiratory syncytial virus was detected using multiplex PCR, indices of pulmonary function were determined using a pulmonary function test, and serum IP-10 was determined using ELISA. To compare the detection of respiratory syncytial virus and the IP-10 level in patients with AECOPD with different levels of pulmonary function, patients were divided into group A(only infected with respiratory syncytial virus), group B(infected with respiratory syncytial virus and another virus), group C(not infected with respiratory syncytial virus) and group D(not infected with any virus). Serum levels of inflammatory factors and IP-10 and their relationship to syncytial virus infection were compared. Results Respiratory virus infection was detected in 67(53.60%) of 125 patients with AECOPD. A total of 69 strains were detected, and those strains were mainly influenza virus A(28.99%), respiratory syncytial virus(26.09%), and influenza virus B(20.29%). The classification of pulmonary function indicated that 21 patients were grade Ⅰ, 42 were grade Ⅱ, 51 were grade Ⅲ, and 11 cases were grade IV. The rate of detection of the respiratory syncytial virus and the serum IP-10 level differed significantly among the four groups(P<0.05 or P<0.01), and the rate at which the respiratory syncytial virus was detected and the serum IP-10 level increased with an increase in grade. Pearson correlation analysis indicated that there was a negative correlation between the serum IP-10 level and FEV1(r=-0.626, 95% CI:-0.699--0.539, P<0.01). Serum levels of the inflammatory factor IL-1 β, IL-8, IFN-γ, TNF-α, and IP10 differed significantly among the 4 groups. Serum levels of inflammatory factors in groups A, B, and C were significantly higher than those in group D, and those in group B were significantly higher than those in groups A and C(P<0.05 for all). Serum levels of IL-1β, IL-8, IFN-γ, TNF-α, and IP-10 in patients infected with the respiratory syncytial virus decreased significantly after treatment(P<0.01). Conclusion The respiratory viruses infecting patients with AECOPD are mainly influenza virus A, respiratory syncytial virus, and influenza virus B. Infection with the respiratory syncytial virus can aggravate disease progression by inducing the expression of IP-10.