慢性阻塞性肺疾病急性加重期呼吸道病毒感染影响因素  

Influencing factors of respiratory virus infection in acute exacerbation of chronic obstructive pulmonary disease patients

作　　者：王硕莹 张节平 吴文娟 孙京焕 曾妮[1] 黄少祥[1] WANG Shuo-ying;ZHANG Jie-ping;WU Wen-juan;SUN Jing-huan;ZENG Ni;HUANG Shao-xiang(Tianjin Fifth Central Hospital,Tianjin 300450,China)

机构地区：[1]天津市第五中心医院呼吸内科,天津300450

出　　处：《中华医院感染学杂志》2021年第19期2988-2992,共5页Chinese Journal of Nosocomiology

基　　金：天津市卫生局科技基金资助项目(2014KZ019)。

摘　　要：目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者呼吸道病毒感染的影响因素,为优化临床诊断和治疗工作提供依据。方法选取2017年5月-2020年5月天津市第五中心医院收治的205例AECOPD患者为研究对象,对其入院时的痰样本进行呼吸道病毒核酸检测判定是否存在病毒感染,根据是否发生病毒感染将患者分为病毒感染组和非病毒感染组。对两组患者的一般资料、临床特征及入院时的血清炎症因子水平进行对比和分析,归纳AECOPD住院患者呼吸道病毒感染的影响因素。结果75例患者痰样本病毒核酸检测阳性,感染率为36.59%(75/205),检出的病毒种类中以甲型流感病毒和鼻病毒为主,检出3例(4.00%)混合感染。病毒感染组患者的应用吸入糖皮质激素占比、合并糖尿病占比及稳定期慢性阻塞性肺疾病评估测试(CAT)评分均高于非病毒感染组,入院时外周血CD_(8)^(+)T淋巴细胞低于非病毒感染组(P<0.05)。病毒感染组患者入院时血清C-反应蛋白(CRP)、干扰素诱导蛋白-10(IP-10)、肿瘤坏死因子-α(TNF-α)水平分别为(55.02±19.64)mg/L、(176.46±15.06)ng/L、(38.82±17.73)ng/L均高于非病毒感染组(P<0.05);稳定期CAT评分及入院时血清IP-10、TNF-α是AECOPD住院患者合并呼吸道病毒感染的影响因素(P<0.05)。结论合并呼吸道病毒感染的AECOPD患者可表现为血清炎症因子水平升高,其中IP-10、TNF-α水平与感染的发生具有相关性,临床应对患者的炎症因子水平给予密切监测、全面评价其病毒感染风险、提升临床诊断和治疗效果,从而改善患者的预后。OBJECTIVE To analyze the influencing factors of respiratory virus infection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),so as to provide basis for optimizing clinical diagnosis and treatment.METHODS Totally 205cases of AECOPD patients hospitalized in the Fifth Central Hospital of Tianjin City from May 2017to May 2020were selected as the research subjects,and the sputum samples were detected for virus nucleic acid to determine whether there was virus infection.According to whether a viral infection occured,the patients were divided into the virus infection group and the non-virus infection group.The general data,the clinical characteristics and the serum inflammatory factors levels of the two groups of patients were compared and analyzed,and the influencing factors of viral infection in hospitalized patients with AECOPD were summarized.RESULTS Totally 75cases of sputum samples were positive for viral nucleic acid detection,and the infection rate was 36.59%(75/205).The main types of viruses detected were influenza A virus and rhinovirus,and 3cases(4.00%)of mixed infection were detected.The proportion of inhaled glucocorticoids,the proportion of diabetes mellitus and the chronic obstructive pulmonary disease assessment test(CAT)score in the viral infection group were significantly higher than those in the non-viral infection group,and the percentage of CD_(8)^(+)T lymphocytes in peripheral blood at admission was significantly lower than that in the non-viral infection group(P<0.05).The serum levels of C-reactive protein(CRP),interferon inducible protein(IP-10),tumor necrosis factor-α(TNF-α)of the patients in the viral infection group at admission were(55.02±19.64)mg/L,(176.46±15.06)ng/L and(38.82±17.73)ng/L,respectively,significantly higher than those in the non-viral infection group(P<0.05).Cat score at stable stage and serum IP-10and TNF at admission-αat admission were the influencing factor of respiratory virus infection in hospitalized patients with AECOPD(P<0.05).C

关 键 词：炎症因子 慢性阻塞性肺疾病急性加重 呼吸道病毒 感染 影响因素 

分 类 号：R563[医药卫生—呼吸系统]