成人呼吸道合胞病毒下呼吸道感染临床特征和预后分析

目的 分析成人呼吸道合胞病毒(RSV)下呼吸道感染患者的临床特征及预后.方法 以2016年8月至2019年11月入住中日友好医院呼吸科或重症监护病房(ICU)的RSV核酸阳性患者148例为研究对象,同时取甲型流感病毒(FluA)核酸阳性的下呼吸道感染患者266例为对照组,根据是否合并免疫功能低下,分为免疫功能正常组和免...     

AECOPD患者感染呼吸道病毒特征及呼吸道合胞病毒感染与血清IP-10的关系北大核心CSCD

目的研究慢性阻塞性肺疾病急性加重(AECOPD)患者感染呼吸道病毒特征,以及呼吸道合胞病毒感染与患者血清IP-10的关系。方法选择本院2019年1月-2020年10月收治的AECOPD患者125例,取咽试子标本,采用多重PCR的方法检查呼吸道病毒等的感染情况,采用肺功能检测仪检查患者的肺功能指标,ELISA的方法检测血清IP-10水平,比较不同肺功能分级AECOPD患者呼吸道合胞病毒检出情况以及IP-10水平。根据患者感染情况分为A组(仅感染呼吸道合胞病毒)、B组(呼吸道合胞病毒感染合并其他病毒感染)、C组(非呼吸道合胞病毒感染)、D组(未检测到病毒感染),比较4组患者血清炎性因子和IP-10水平及其与合胞病毒感染的关系。结果 125例AECOPD患者中67例(53.60%)检出呼吸道病毒感染,共检出病毒69株,主要为流感病毒A(占28.99%),呼吸道合胞病毒(占26.09%)和流感病毒B(占20.29%)。125例患者按肺功能分级,Ⅰ级21例,Ⅱ级42例,Ⅲ级51例,IV级11例。4组患者的呼吸道合胞病毒检出率、血清IP-10水平差异均有统计学意义(P<0.05或P<0.01),且随分级的增加呼吸道合胞病毒检出率和血清IP-10水平增高。Pearson相关分析显示,血清IP-10水平与FEV1值呈负相关性(r=-0.626,95%CI:-0.699~-0.539,P<0.01)。4组患者的血清炎性因子IL-1β、IL-8、IFN-γ、TNF-α和IP-10差异均有统计学意义(均P<0.01),其中A、B、C组血清炎性因子水平均显著高于D组,B组显著高于A、C组(均P<0.05)。呼吸道合胞病毒感染患者经治疗后血清IL-1β、IL-8、IFN-γ、TNF-α、IP-10水平均显著降低(均P<0.01)。结论 AECOPD患者感染的呼吸道病毒主要为流感病毒A、呼吸道合胞病毒和流感病毒B,其中呼吸道合胞病毒感染可通过诱导IP-10的表达加重疾病进展。     

慢性阻塞性肺疾病稳定期患者呼吸道合胞病毒感染与气道炎症的关系

目的通过对慢性阻塞性肺疾病(COPD)稳定期患者诱导痰中呼吸道分胞病毒(RSV)-RNA、白细胞介素(IL)-6、IL-8、基质金属蛋白酶(MMP)-12的浓度测定来探讨RSV感染与COPD稳定期患者气道炎症的关系。方法选取80例COPD稳定期患者及20例健康志愿者,分为试验组和正常对照组,用逆转录-聚合酶链反应(RT-PCR)和酶联免疫吸附试验法(ELISA)测定受试者诱导痰RSV-RNA拷贝数和痰液中炎性因子IL-6、IL-8及MMP-12的浓度,探讨RSV感染与COPD稳定期患者气道炎症的关系。结果 80例COPD稳定期患者中RSV阳性有23例,阳性率28.75%,正常对照组中无RSV阳性者,且RSV阳性病人痰液中IL-6、IL-8、MMP-12的浓度明显高于RSV阴性组及正常对照组(P0.05)。结论 RSV感染与COPD稳定期患者的气道炎症有较强的相关性,RSV病毒感染的检测对于了解COPD的病情和指导进一步的治疗具有重要参考价值。     

AECOPD治疗前后C反应蛋白变化的临床意义

目的探讨慢性阻塞性肺病急性加重期（AECOPD）患者治疗前、治疗后C反应蛋白（CRP）变化及临床意义。方法选择AECOPD患者82例,分别测定应用抗生素治疗前后CRP、WBC计数,并比较这些指标的变化情况。结果C反应蛋白在患者人院时的总阳性率为81．70％。在治疗后,CRP在WBC还未有显著变化时已经明显下降,其治疗前后的差异具有统计学意义（P〈0.01）。结论CRP作为反映细菌性感染的敏感指标,肺部感染严重程度和反映抗生素疗效方面具有重要意义。     

AECOPD住院期间cTnT预后价值初探

目的评价cTnT在慢性阻塞性肺疾病急性加重期（AECOPD）住院期间的预后价值。方法采用前瞻性队列研究方法,测定82例AECOPD住院患者血清cTnT、Mb、CK-MBmass,收集患者临床资料,随访临床结局（死亡或存活）。采用单因素、Logistic回归分析进行预后分析。结果logistic多元回归分析结果显示,PaO2、cTnT增高、P（A-a）O2、年龄为AECOPD住院期间的主要预后因素（P〈0．05）。结论cTnT增高是AECOPD住院期间的主要预后指标。     

探讨血清C-反应蛋白在AECOPD中的临床意义

目的 探讨C-反应蛋白在AECOPD诊疗中临床意义.方法 对比分析87例AECOPD患者治疗前后血清C-反应蛋白水平、白细胞总数、血沉、体温,肺功能变化情况.结果 C-反应蛋白在患者入院时的阳性率为93.10%,明显高于其他常规临床指标.治疗后C-反应蛋白明显下降,与治疗前比较差异有统计学意义(P<0.01).结论 C-反应蛋白是反映细茵性感染的敏感指标,对指导AECOPD的诊断和治疗有重要作用.     

也门儿童的人麦塔肺病毒和呼吸道合胞病毒

发展中国家中能够增加呼吸道感染严重性的因素很少被关注。我们报道的因素与发生在也门儿童的严重的呼吸系统疾病有关（266位呼吸合胞病毒感染和66位人麦塔肺病毒感染）．年龄．室内空气污染和不完全接种疫苗是危险因素．这不同于发达国家．     

AECOPD患者C反应蛋白检测的临床意义

目的 检测并分析AECOPD病人C反应蛋白治疗前后的变化,探讨其动态变化的临床价值.方法 选择42例AECOPD患者,检测其在治疗前及使用抗生素后10~14天的CRP水平,分析这些指标的变化情况,并分析其与白细胞总数及中性粒细胞比例的相关性.结果 在急性加重期CRP水平明显升高(57.224±54.86552 mg/L),而治疗后迅速下降(10.3976±15.1405 mg/L),其变化差异具有统计学意义,且与白细胞总数及中性粒细胞比例具有显著相关性,此外CRP与预后具有正相关,抗感染疗程及住院时间有随CRP增高而延长趋势.结论 CRP检测对COPD急性加重期感染的诊断及疗效观察、预后判定具有一定的辅助诊断意义.     

超敏C反应蛋白在AECOPD中的临床价值

目的探讨超敏C反应蛋白(HSCRP)在AECOPD患者中的临床价值。方法检测30例稳定期COPD患者以及30例AECOPD患者治疗前后的血清HSCRP、白细胞计数(WBC)、中性粒细胞百分率(N%),比较其在稳定期COPD患者与AE-COPD患者治疗前后之间的差异。结果 AECOPD患者治疗前HSCRP水平显著高于治疗后及稳定期COPD患者(P<0.01),治疗前WBC、N%水平高于与治疗后(P<0.05),治疗后HSCRP、WBC、N%水平与稳定期COPD患者相比无显著性差异(P>0.05)。结论 HSCRP是反应机体炎症反应的敏感指标,对AECOPD的及早诊断及疗效判定具有重要临床价值。     

Cytokines and respiratory syncytial virus infection

Respiratory syncytial virus (RSV) is a single-stranded negative sense RNA virus in the Paramyxovirus family that is a major cause of morbidity and life-threatening lower respiratory tract disease in infants and young children worldwide. RSV is recognized as a ubiquitous virus having considerable worldwide disease burden. Studies investigating the immune response and disease pathogenesis associated with infection attribute the interplay of the virus with host factors, particularly cytokines and chemokines, in inflammation, disease, and immune effector processes. There is convincing evidence that Th1- and Th2-type cytokine patterns determine the type of immune response to RSV infection, and that the spectrum of cytokine expression affects control mechanisms involved in the regulation of disease pathogenesis and chronicity. Thus, there is a critical need to identify virus and host mechanisms that regulate cytokine expression to allow for intervention strategies to control disease pathogenesis. In this report, we discuss the role of cytokines and chemokines in the response to RSV infection, and the potential role for suppressor of cytokine signaling (SOCS) proteins in regulating these responses.     

The immunologic response to infection with respiratory syncytial virus in infants.

Fifty infants younger than six months, hospitalized for infection with respiratory syncytial virus (RSV), were studied by examination of serial samples of nasal secretion. Secretory neutralizing activity was measured by plaque reduction and secretory antibody by indirect fluorescence using conjugated antiserum to human IgA, IgG, or IgM. Secretory neutralizing activity during infection rose or fell fourfold with approximately equal frequency (20% and 26%, respectively). In contrast, levels of IgA antibody to RSV in secretions rose fourfold in 56%--65% of the infants and fell in none. The frequency of such rises in titer of antibody was directly related to age. In individual secretions the correlation between neutralizing activity and IgA antibody to RSV was poor: neutralizing activity was often found in the absence of detectable antibody, and IgA antibody to RSV was often nonneutralizing. Nevertheless, the development of IgA antibody to RSV correlated in time with the disappearance of virus from the respiratory tract. The timing of this secretory response is consistent with the hypothesis that antibody contributes significantly to cure of infection.     

Management of respiratory syncytial virus infection

Although bronchiolitis is the most common viral lower respiratory tract infection in infancy and childhood, and the virus responsible (respiratory syncytial virus) was discovered half a century ago, there is no effective treatment available. The antiviral agent ribavirin has not lived up to expectations and should be reserved for selected cases. Corticosteroids have not been shown to be effective in individual trials, although a recent meta-analysis suggested a mild beneficial short-term effect. Bronchodilators can be used on a trial-and-error basis. Prophylaxis with intravenous immunoglobulins enriched for anti-respiratory syncytial virus antibodies or humanized monoclonal antibodies can reduce the rates of related hospitalization by 50% when used in high-risk patients. However, logistical problems with the administration of intravenous immunoglobulins and the cost of both products preclude their widespread use.     

Effect of aging on cytokine production in response to respiratory syncytial virus infection

In vitro cytokine production in response to respiratory syncytial virus (RSV) and influenza infections was investigated in 11 "young" (mean age, 31 years) and "older" (mean age, 75 years) healthy volunteers by use of interferon (IFN)-gamma ELISPOT and ELISA analysis of cytokines in culture supernatants. Autologous dendritic cells (DCs), derived by culturing adherent peripheral blood mononuclear cells in granulocyte-macrophage colony--stimulating factor and interleukin-4, were used as antigen-presenting cells. Older subjects produced significantly fewer IFN-gamma ELISPOTs in response to RSV than the younger subjects. These results suggest that aging may be associated with a defect in the T cell response to RSV, even when DCs are used to maximize costimulation. This defect in cellular immunity may be related to the increased morbidity observed with RSV infection in elderly persons.     

小鼠的原发性呼吸道合胞病毒感染

目的研究呼吸道合胞病毒（RSV）感染模型的建立。方法实验组用在HEP-2细胞上培养出的不同滴度(7.5×105,2.75×106,2.5×107PFU/ml)的98159株RSV予Balb/c小鼠滴鼻,每个滴度3只小鼠,共9只。对照组3只小鼠用HEP-2细胞悬液滴鼻,5d后,无菌状态下取肺,右肺称重,按1∶10加入eagleMEM,匀浆,4℃,2000r/min离心20min,上清液加入HEP-2细胞作病毒分离,空斑分析。左肺用于病理检查,电镜检查。结果(1)RSV感染使梭形的HEP-2细胞融合成地图状、圆形、椭圆形、树枝状;(2)肺组织匀浆接种于HEP-2细胞上,于接种的10～12d分离出病毒;(3)不同滴度的RSV在肺组织中的复制滴度不同,滴度越高,肺复制滴度越高;(4)较高滴度的RSV感染小鼠,肺组织病毒复制于感染后的4～6d达高峰,肺病理变化于5～8d最明显,可见炎症细胞浸润,主要是淋巴细胞;低滴度RSV感染小鼠后病理变化不明显;(5)电镜检查高倍镜下可见毛刺样外观的病毒,病变呈横切或纵切。结论采用98159株呼吸道合胞病毒滴鼻可成功地在Balb/c小鼠身上复制出RSV肺部感染的模型。     

Severe respiratory syncytial virus pneumonia associated with primary Epstein-Barr virus infection

This is a case report of a child with severe respiratory syncytial virus (RSV) pneumonia and concurrent infection with Epstein-Barr virus. We hypothesize that immunosuppression due to EBV may have contributed to the severity of his RSV infection. The diagnosis of RSV infection was facilitated by bronchoalveolar lavage.     

AECOPD患者呼吸道病毒感染与气道重塑的相关性研究

目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者呼吸道病毒感染与气道重塑的相关性.方法 选择2017年9月-2019年6月于我院就诊并确诊AECOPD的患者96例.检测患者呼吸道分泌物FLU-A、B,RSV,ADV,PIV-1、2、3型及HRV阳性情况.入院后予以规范化的AECOPD治疗方式,分别于出院时及出院...