肺炎衣原体与新型冠状病毒共感染及其对机体炎症因子分泌水平的影响  

Co-infection of Chlamydia pneumoniae and SARS-CoV-2 and its effect on the secretion of inflammatory cytokines

作　　者：李佳艳[1] 袁丽萍 罗庆凯[1] 雷晔飞[3] 李园 张峰华[3] 彭丽秀[3] 欧阳育琪[3] 唐时幸 陈虹亮[1,3] LI Jia-yan;YUAN Li-ping;LUO Qing-kai;LEI Ye-fei;LI Yuan;ZHANG Feng-hua;PENG Li-xiu;OUYANG Yu-qi;TANG Shi-xing;CHEN Hong-liang(Department of Respiratory Intensive Care Unit,The First People’s Hospital of Chenzhou,Chenzhou 423000,China;School of Public Health,Southern Medical University,Guangzhou 510000,China;Department of Healthcare-associated Infection management,The First People’s Hospital of Chenzhou,Chenzhou 423000,China)

机构地区：[1]郴州市第一人民医院呼吸重症监护室,湖南郴州423000 [2]南方医科大学公共卫生学院,广东广州510000 [3]郴州市第一人民医院感控科,湖南郴州423000

出　　处：《中国感染控制杂志》2024年第11期1391-1397,共7页Chinese Journal of Infection Control

基　　金：湖南省自然科学基金项目(2024JJ7032);湖南省卫生健康高层次人才重大科研专项(R2023065);白求恩公益基金项目(20221206-03)。

摘　　要：目的明确肺炎衣原体(Cpn)与新型冠状病毒(SARS-CoV-2)共感染的特征及其对SARS-CoV-2诱导机体炎症反应的影响。方法选取2022年12月20日—2023年2月20日郴州市某医院就诊的新型冠状病毒感染(COVID-19)患者,按COVID-19严重程度将重型和危重型作为重症组,轻型和中型作为轻症组,再依据患者年龄(≥18岁为成年,<18岁为未成年)分为成年重症组、成年轻症组、未成年重症组、未成年轻症组。采用倾向性评分对重症组、轻症组患者的年龄、性别、基础疾病进行1∶1匹配。收集患者支气管肺泡灌洗液(BALF)、咽拭子及血清标本,应用酶联免疫吸附测定法(ELISA)检测Cpn IgG/IgM抗体,流式细胞术检测BALF中白细胞介素(IL)-8等12项常见细胞因子水平,并比较各组之间的差异。结果共纳入102例患者,其中重型和危重型(重症)患者61例,轻型和中型(轻症)患者41例;年龄≥18岁的患者71例,年龄<18岁未成年患者31例。成年重症组患者39例,成年轻型组患者32例,经倾向性评分成功匹配30对;未成年重症组患者22例,未成年轻型组患者9例,经倾向性评分成功匹配8对。COVID-19患者中Cpn IgG、IgM阳性率分别为36.27%(37例)、8.82%(9例),其中1例Cpn IgG和IgM同为阳性。成人重症组合并Cpn IgG阳性患者血清标本中干扰素(IFN)-α水平高于IgG阴性患者(P=0.037),两组患者BALF、血清标本中其他细胞因子水平比较差异均无统计学意义(均P>0.05);成人轻症组合并Cpn IgG阳性患者血清标本中IL-8和IL-17水平均高于Cpn IgG阴性患者(均P<0.05)。未成年轻症组合并Cpn IgM阳性患者BALF及血清标本中IL-8水平均高于Cpn IgM阴性患者(均P<0.05)。Logistic回归分析结果显示,Cpn IgG阳性和IgM阳性都不是导致COVID-19发展成重症的危险因素。结论合并Cpn感染不是导致COVID-19患者发展成重症的危险因素,Cpn感染对SARS-CoV-2导致的炎症因子分泌影响有限。Objective To explore characteristics of co-infection of Chlamydia pneumoniae(Cpn)and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),and identify their effect on SARS-CoV-2-induced inflammatory response.Methods Patients with coronavirus disease 2019(COVID-19)who received treatment in a hospital in Chenzhou City from December 20,2022 to February 20,2023 were selected.According to the severity of COVID-19,severe and critical cases were classified as the severe symptom group,while mild and moderate cases were classified as the mild symptom group.Meanwhile,according to the age of patients(≥18 years old as adults,<18 years old as juveniles),they were divided into the adult severe symptom group,adult mild symptom group,juvenile severe symptom group,and juvenile mild symptom group.Propensity score was adopted to match age,gender,and underlying diseases of patients in severe symptom and mild symptom group in a 1∶1 ratio.Bronchoalveolar lavage fluid(BALF),throat swabs,and serum specimens of patients were collected.Cpn IgG/IgM antibody was detected by enzyme-linked immunosorbent assay(ELISA),levels of 12 common cytokines(including interleukin-8[IL-8])in BALF were detected by flow cytometry,differences among groups were compared.Results A total of 102 patients were included,with 61 severe and critical(severe symptom)patients,as well as 41 mild and moderate(mild symptom)patients.There were 71 patients aged≥18 years and 31 juvenile patients aged<18 years.There were 39 patients in the adult severe symptom group and 32 in the adult mild symptom group,and 30 pairs were successfully matched through propensity score analysis.There were 22 patients in the juvenile severe symptom group and 9 in the juvenile mild symptom group,and 8 pairs were successfully matched through propensity score analysis.Among COVID-19 patients,the positive rates of Cpn IgG and IgM were 36.27%(n=37)and 8.82%(n=9),respectively,with 1 case positive for both Cpn IgG and IgM.The level of interferon(IFN)-αin serum specimens from adult patients

关 键 词：新型冠状病毒 肺炎衣原体 新型冠状病毒感染 炎症因子 CPN COVID-19 SARS-CoV-2 

分 类 号：R563.1[医药卫生—呼吸系统] R181.32[医药卫生—内科学]