摘要目的 探讨慢性阻塞性肺疾病(慢阻肺)急性加重期呼吸道病毒感染疾病特点及其与炎症细胞因子的相关性.方法 前瞻性纳入2015年10月至2017年9月上海交通大学医学院附属瑞金医院慢阻肺急性加重患者,共纳入慢阻肺急性加重期患者99例,其中男81例,女18例,年龄54~93岁,平均(74±10)岁.收集所有患者的痰液,使用多通道实时荧光定量PCR检测15种呼吸道病毒,分析病毒阳性结果相关的临床特点;使用ELISA法检测患者血清中IL?6、IL?8、可溶性IL?2受体(sIL?2R)、干扰素?γ、干扰素诱导蛋白(IP?10)、调节活化正常T细胞表达和趋化因子(RANTES)及肿瘤坏死因子?α (TNF?α)等炎症因子水平,评估与呼吸道病毒感染的相关性,并建立判别模型.结果 99例患者中病毒检测阳性34例(34%),其中流感A型病毒阳性率最高(38%,13/34),其次为鼻病毒(35%,12/34).多因素logistic回归分析显示,发热、稳定期慢阻肺评估测试(CAT)评分、血清IP?10和TNF?α水平与慢阻肺急性加重期呼吸道病毒感染相关(OR值分别为19.146、1.211、1.010和1.086,均P<0.05).血清IP?10及sIL?2R水平在流感A型病毒阳性患者中显著升高.结论 呼吸道病毒感染在慢阻肺急性加重期常见,流感A型病毒和鼻病毒检出率最高;发热是常见症状;稳定期呼吸道症状严重者对病毒易感.呼吸道病毒感染导致系统性炎症水平升高,流感病毒尤为显著.由发热、稳定期CAT评分、血清IP?10和TNF?α水平组成的判别模型对提示慢阻肺急性加重期呼吸道病毒感染有意义.

abstractsObjective To investigate the characteristics of respiratory viral infections, and correlation between inflammatory cytokines and respiratory virus infections in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). Methods A prospective cohort of patients with acute exacerbations of COPD was enrolled. The sputum of all patients were collected,and 15 respiratory viruses were detected using multi ? channel real ? time fluorescence quantitative PCR. The clinical characteristics associated with viral infections were analyzed. The peripheral blood of the patients was collected and cytokines including IL?6, IL?8, RANTES, IP?10, sIL?2R, IFN?γ, TNF?α in the serum were detected by ELISA. Association of these cytokines with respiratory viral infections was evaluated and a discriminant model was established. Results A total of 99 patients with acute exacerbations of COPD were enrolled in this study. Thirty?four cases (34.3%, 34/99) were positive for viral detection. Among them, the positive rate of influenza A virus was the highest (38.2%, 13/34), followed by rhinovirus (35.3%, 12/34). Multifactor logistic regression analysis showed that,fever, COPD assessment test (CAT) score in stable stage, serum IP?10 and TNF? α levels were correlated with respiratory viral infections in patients with acute exacerbations of COPD. The levels of serum IP?10 and sIL?2R increased significantly in patients with influenza A virus. Conclusions Respiratory viral infections were common in acute exacerbations of COPD. Influenza A virus and rhinovirus were the two most common viruses. Fever was a common symptom. Patients with severe respiratory symptoms at stable stage were susceptible to viral infection. Viral infection was associated with an increase in systemic inflammatory levels,most significantly in influenza virus infection. A discriminant model composed of fever, CAT score in stable stage, serum IP?10 and TNF?α levels can be used to predict respiratory viral infections in acute exacerbations of COPD.