COPD合并呼吸道病毒感染患者的病毒分布、血清细胞因子水平及其临床意义

Virus distribution and serum cytokine level in patients with chronic obstructive pulmonary disease complicated with respiratory virus infection and their clinical significance

目的探讨慢性阻塞性肺疾病(COPD)合并呼吸道病毒感染患者的病毒分布、血清细胞因子水平及其临床意义。方法回顾性分析2019年10月至2021年10月期间西安国际医学中心医院呼吸内科收治的82例COPD患者的临床资料。所有患者在入院当天检测血清细胞因子和肺功能,采用聚合酶链式反应检测患者病毒感染情况,根据其是否合并有呼吸道病毒感染,将其分为未合并呼吸道病毒感染组42例和合并呼吸道病毒感染组40例。比较两组患者血清白细胞介素-6(IL-6)、白细胞介素-18(IL-18)、干扰素(IFN-α、IFN-γ)和肿瘤坏死因子(TNF-α、TNF-β)水平及其临床表现和肺功能分级。结果合并呼吸道病毒感染组患者主要以鼻病毒(13.41%)和呼吸道合胞病毒(10.97%)为主;未合并呼吸道病毒感染组患者的血清IL-6、IL-18水平分别为(27.89±4.87)mg/L、(125.72±20.45)mg/L,明显低于合并呼吸道病毒感染组患者的(35.06±6.02)mg/L、(152.46±23.12)mg/L,而IFN-α、IFN-γ、TNF-α、TNF-β水平分别为(35.46±6.02)pg/mL、(65.64±5.01)pg/L、(62.78±5.03)ng/mL、(118.31±7.23)ng/L,明显高于合并呼吸道病毒感染组的(23.48±3.16)pg/mL、(46.98±4.86)pg/L、(47.96±4.32)ng/mL、(93.46±7.02)ng/L,差异均有统计学意义(P<0.05);合并呼吸道病毒感染组患者的咽痛、肺功能Ⅳ级的占比分别为20.00%、32.50%,明显高于未合并呼吸道病毒感染组的4.76%、11.90%,差异均有统计学意义(P<0.05)。结论COPD合并呼吸道病毒感染患者的病毒分布主要以鼻病毒与呼吸道合胞病毒为主,血清细胞因子水平对COPD合并呼吸道病毒感染的诊断有一定的参考价值。

Objective To investigate the distribution of virus and serum cytokine level and its clinical significance in patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory virus infection.Methods The clinical data of 82 COPD patients admitted to Department of Respiratory Medicine,Xi'an International Medical Center Hospital from October 2019 to October 2021 were retrospectively analyzed.All patients were tested for serum cytokines and lung function on the day of admission.Polymerase chain reaction was used to detect the viral infection of patients.According to whether they were complicated with respiratory virus infection,the patients were divided into a group without respiratory virus infection(42 cases)and a group with respiratory virus infection(40 cases).The serum levels of interleukin-6(IL-6),interleukin-18(IL-18),interferons(IFN-α,IFN-γ),and tumor necrosis factors(TNF-α,TNF-β),and their clinical manifestations and pulmonary function grades were compared between the two groups.Results The virus in patients with respiratory virus infection were mainly rhinovirus(13.41%)and respiratory syncytial virus(10.97%).The serum levels of IL-6 and IL-18 in patients without respiratory virus infection were(27.89±4.87)mg/L and(125.72±20.45)mg/L,which were significantly lower than(35.06±6.02)mg/L and(152.46±23.12)mg/L in patients with respiratory virus infection,while IFN-α,IFN-γ,TNF-α,TNF-βlevels were(35.46±6.02)pg/mL,(65.64±5.01)pg/L,(62.78±5.03)ng/mL,and(118.31±7.23)ng/L,which were significantly higher than(23.48±3.16)pg/mL,(46.98±4.86)pg/L,(47.96±4.32)ng/mL,and(93.46±7.02)ng/L in the patients with respiratory virus infection;the differences were statistically significant(P<0.05).The percentages of patients with pharyngeal pain and pulmonary function gradeⅣin patients with respiratory virus infection were 20.00%and 32.50%,which were significantly higher than 4.76%and 11.90%in patients without respiratory virus infection(P<0.05).Conclusion The viruses detected in COPD patients with respiratory virus infection were mainly rhinovirus and respiratory syncytial virus,and the serum cytokine level has a certain reference value for the diagnosis of COPD patients with respiratory virus infection.