EB病毒感染对慢性阻塞性肺疾病急性加重期炎症反应影响41例临床研究

Effect of Epstein-Barr virus infection on the inflammatory response in the acute exacerbation of chronic obstructive pulmonary disease

目的研究EB病毒感染对慢性阻塞性肺疾病(慢阻肺)急性加重影响。方法将贵州省人民医院呼吸与危重症医学科2015年10月至2017年8月收治的156慢阻肺急性加重期患者分为EB病毒感染组41例,EB病毒未感染组115例。采用聚合酶链式反应(PCR)检测患者外周血EB病毒DNA,酶联免疫吸附试验(ElISA)检测血清EB抗体IgG、IgM和检测血清中降钙素原(PCT)、C反应蛋白(CRP)、白介素(IL)-6、IL-17、IL-10等表达情况。痰培养和药敏实验分析细菌学特点。分析EB病毒感染患者合并肺部感染常见病原菌特点,对其治疗效果、预后进行综合分析。结果 EB病毒感染的慢阻肺急性加重患者肺部感染血清中的PCT、CRP、IL-6、IL-17、IL-10显著高于非EB病毒感染的慢阻肺急性加重患者,其病原学特点为感染EB病毒患者多为革兰阴性菌所致的肺部感染,且耐药菌比例增加,抗感染治疗时间延长、并发症增加、入住重症病房比例增加。血气方面,感染EB病毒的慢阻肺急性加重患者其PaCO2明显升高,PaO2明显下降,且差异具有统计学意义。而肺功能方面,两组间未见明显差异。结论 EB病毒感染后加重慢阻肺急性加重患者炎症反应程度、促进病情进展与恶化。

Objective To study the effect of Epstein-Barr virus(EB) virus infection on acute exacerbation of chronic obstructive pulmonary disease. Methods 156 patients with acute exacerbation of chronic obstructive pulmonary disease were divided into two groups, 41 patients with EB virus infection and the group 115 patients without EB virus infection.which colleceted from the Department of Respiratory and Critical Care Medicine, Guizhou Provincial People’s Hospital From October 2015 to August 2017. Epstein-Barr virus(EB) DNA was detected by PCR, serum EB antibody IgG and IgM were detected by Elisa, and the expression level of PCT, CRP, IL6,IL-17 and IL-10 in serum were detected by Elisa.Sputum culture and sensitivity were used to analyze the bacteriological characteristics. The characteristics of common pathogens of pulmonary infection were also analyzed in patients with Epstein-Barr virus(EBV) infection,and the therapeutic effects and prognosis were analyzed comprehensively. Results The EBV-infected AECOPD patients had significantly higher levels of PCT, CRP and IL-6 IL-17, IL-10 in serum of patients with lung infection than those of AECOPD patients with non-EB virus infection. The etiological characteristics of EBV-infected AECOPD patients were mostly G-, The EBV-infected AECOPD patients whose the proportion of drug-resistant bacteria increased, anti-infective treatment time prolonged, complications increased, admitted to intensive care unit increased. Blood gas, the infection of Epstein-Barr virus AECOPD patients was significantly higher PaCO2, PaO2 decreased significantly, and the difference was statistically significant. However, the lung function, no significant difference between the two groups. Conclusion EBV infection aggravates inflammatory response in patients with AECOPD, and promotes the progress and deterioration of the disease.