AECOPD患者呼吸道病毒检测结果及危险因素
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摘要
目的分析慢性阻塞性肺疾病急性加重(AECOPD)患者呼吸道病毒的感染情况及其危险因素。方法选取2016年1月至2017年6月本院呼吸内科收治的AECOPD患者118例,通过鼻咽拭子采集患者的呼吸道病毒标本,采用PCR法检测病毒,通过痰培养检测细菌/真菌,同时记录患者的病历资料等,采用Logistic回归分析病毒感染相关危险因素。结果痰培养阳性率为19.49%(23/118),PCR检测呼吸道病毒阳性率为41.53%(49/118),细菌和病毒混合感染发生率为7.63%(9/118);病毒阳性患者的住院时间为(12.54±2.12)d,显著长于病毒阴性患者的(8.37±1.51)d,差异有统计学意义(P<0.05);多因素逐步回归分析筛选出的AECOPD患者病毒感染的危险因素包括吸烟、糖尿病、呼吸衰竭以及既往1年内急性加重次数。结论 AECOPD患者呼吸道病毒感染率较高,尽早戒烟和控制血糖、改善肺功能、减少急性加重对降低AECOPD患者病毒感染风险具有重要意义。
Objective To investigate the distribution of respiratory viruses in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and analyze the risk factors of viral infection. Methods 118 patients with AECOPD from January 2016 to June 2017 in our hospital were enrolled into this study. Respiratory tract virus infection was detected by PCR and bacterial/fungal infection was detected by sputum culture. Using Logistic regression analysis was used to explore the related risk factors of viral infection. Results The positive rate of sputum culture was 19.49%(23/118). The positive rate of respiratory virus was 41.53%(49/118),and the incidence of mixed infection of bacteria and virus was 7.63%(9/118). The hospitalization time in virus positive patients was(12.54±2.12)d,significantly longer than that of virus negative patients[(8.37±1.51)d];the difference was statistically significant(P<0.05). Stepwise regression analysis showed the risk factors of AECOPD patients with virus infection included smoking,diabetes,respiratory failure,acute exacerbation of the past one year. Conclusion AECOPD patients with a high rate of virus infection,and quit smoking,control blood glucose,improve lung function and reduce acute exacerbation of AECOPD patients could help to lower the viral infection risk.
Objective To investigate the distribution of respiratory viruses in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and analyze the risk factors of viral infection. Methods 118 patients with AECOPD from January 2016 to June 2017 in our hospital were enrolled into this study. Respiratory tract virus infection was detected by PCR and bacterial/fungal infection was detected by sputum culture. Using Logistic regression analysis was used to explore the related risk factors of viral infection. Results The positive rate of sputum culture was 19.49%(23/118). The positive rate of respiratory virus was 41.53%(49/118),and the incidence of mixed infection of bacteria and virus was 7.63%(9/118). The hospitalization time in virus positive patients was(12.54±2.12)d,significantly longer than that of virus negative patients[(8.37±1.51)d];the difference was statistically significant(P<0.05). Stepwise regression analysis showed the risk factors of AECOPD patients with virus infection included smoking,diabetes,respiratory failure,acute exacerbation of the past one year. Conclusion AECOPD patients with a high rate of virus infection,and quit smoking,control blood glucose,improve lung function and reduce acute exacerbation of AECOPD patients could help to lower the viral infection risk.
引文
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[11]王宏杰,张凤久,乌晶,等.慢性阻塞性肺疾病急性加重患者呼吸道病毒的检测分析[J].国际病毒学杂志,2016,23(4):239-241.Wang HJ,Zhang FJ,Wu J,et al.Analysis on respiratory viruses infection status in patients with acute exacerbation of chronic obstructive pulmonary disease[J].International Journal of Virology,2016,23(4):239-241.
[12]Kohler M,Sandberg A,Kjellqvist S,et al.Gender differences in the bronchoalveolar lavage cell proteome of patients with chronic obstructive pulmonary disease[J].J Allergy Clin Immunol,2013,131(3):743-751.
[13]Kwak HJ,Park DW,Kim JE,et al.Prevalence and Risk Factors of Respiratory Viral Infections in Exacerbations of Chronic Obstructive Pulmonary Disease[J].Tohoku J Exp Med,2016,240(2):131-139.
[14]秦篙.联合N-乙酰半胱氨酸对AECOPD患者的治疗效果[J].热带医学杂志,2016,16(4):483-485,509.Qin G.The improvement effect of N-acetylcysteine combined with montelukast on pulmonary function and arterial blood gas index for AECOPD[J].J Trop Med,2016,16(4):483-485,509.
[15]龚峰,张晓调,陈显静,等.慢性阻塞性肺疾病急性加重患者相关病毒感染的危险因素分析[J].中华医院感染学杂志,2017,27(4):800-803.Gong F,Zhang XD,Chen XJ,et al.Analysis of risk factors of viral infection in patients with acute exacerbation of COPD[J].Chin J Nosocomiol,2017,27(4):800-803.
[2]Xu N,Chen J,Chang X,et al.n CD64 index as a prognostic biomarker for mortality in acute exacerbation of chronic obstructive pulmonary disease[J].Ann Saudi Med,2016,36(1):37-41.
[3]陈晓,何和章,林容,等.慢性阻塞性肺疾病急性加重期住院患者病毒感染危险因素分析[J].中华医院感染学杂志,2016,26(19):4452-4454.Chen X,He HZ,Lin R,et al.Risk factors of virus infection in patients with acute exacerbations of chronic obstructive pulmonary disease in hospital[J].Chin J Nosocomiol,2016,26(19):4452-4454.
[4]Kim HC,Choi SH,Huh JW,et al.Different pattern of viral infections and clinical outcomes in patient with acute exacerbation of chronic obstructive pulmonary disease and chronic obstructive pulmonary disease with pneumonia[J].J Med Virol,2016,88(12):2092-2099.
[5]Marcos PJ,Sanjuán P,Huerta A,et al.Relationship Between Severity Classification of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Clinical Outcomes in Hospitalized Patients[J].Cureus,2017,9(1):e988.
[6]Koenig SP,Furin J.Update in Tuberculosis/Pulmonary Infections2015[J].Am J Respir Crit Care Med,2016,194(2):142-146.
[7]郑晶晶.慢性阻塞性肺疾病急性加重期住院患者病毒感染危险因素分析[D].广州:南方医科大学,2013.Zheng JJ.A study on risk factors of virus infection in the hospitalized patients with chronic obstructive pulmonary disease[D].Guangzhou:Southern Medical University,2013.
[8]Law S,Kumar P,Woods S,et al.Malnutrition screening in patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease and its association with patient outcomes[J].Hosp Pract(1995),2016,44(4):207-212.
[9]BiancardiE,FennellM,RawlinsonW,et al.Viruses are frequently present as the infecting agent in acute exacerbations of chronic obstructive pulmonary disease in patients presenting to hospital[J].Intern Med J,2016,46(10):1160-1165.
[10]Chhabra SK,Dash DJ.Acute exacerbations of chronic obstructive pulmonary disease:causes and impacts[J].Indian J Chest Dis Allied Sci,2014,56(2):93-104.
[11]王宏杰,张凤久,乌晶,等.慢性阻塞性肺疾病急性加重患者呼吸道病毒的检测分析[J].国际病毒学杂志,2016,23(4):239-241.Wang HJ,Zhang FJ,Wu J,et al.Analysis on respiratory viruses infection status in patients with acute exacerbation of chronic obstructive pulmonary disease[J].International Journal of Virology,2016,23(4):239-241.
[12]Kohler M,Sandberg A,Kjellqvist S,et al.Gender differences in the bronchoalveolar lavage cell proteome of patients with chronic obstructive pulmonary disease[J].J Allergy Clin Immunol,2013,131(3):743-751.
[13]Kwak HJ,Park DW,Kim JE,et al.Prevalence and Risk Factors of Respiratory Viral Infections in Exacerbations of Chronic Obstructive Pulmonary Disease[J].Tohoku J Exp Med,2016,240(2):131-139.
[14]秦篙.联合N-乙酰半胱氨酸对AECOPD患者的治疗效果[J].热带医学杂志,2016,16(4):483-485,509.Qin G.The improvement effect of N-acetylcysteine combined with montelukast on pulmonary function and arterial blood gas index for AECOPD[J].J Trop Med,2016,16(4):483-485,509.
[15]龚峰,张晓调,陈显静,等.慢性阻塞性肺疾病急性加重患者相关病毒感染的危险因素分析[J].中华医院感染学杂志,2017,27(4):800-803.Gong F,Zhang XD,Chen XJ,et al.Analysis of risk factors of viral infection in patients with acute exacerbation of COPD[J].Chin J Nosocomiol,2017,27(4):800-803.