82例AECOPD患者肝功能异常临床处置方案初探

目的分析慢性阻塞性肺疾病急性加重（AECOPD）合并肝损害患者的临床特点、保肝治疗对其预后的影响。方法回顾性分析82例AECOPD合并肝损害者的外周血白细胞计数、中性粒细胞百分比、肝功能及动脉血气分析,并对治疗前后检验结果、住院天数、住院费用、肝功能转归和死亡率进行比较分析。结果 AECOPD患者治疗后症状、动脉血氧分压（PaO2）、外周血白细胞、中性粒细胞百分比和肝功能各参数值较治疗前均有明显改善（P〈0.01）;随pH值、PaO2、PaCO2指标的改善及感染的控制,肝功能亦逐渐恢复至正常。酸中毒时（pH〈7.35）pH值与ALT、AST结果显著负相关,PaO2与ALT、AST结果显著负相关,PaCO2与ALT、AST结果显著正相关。结论 AECOPD患者肝脏功能有明显的损害,给予抗感染等原发病治疗,肝功能可恢复正常,但常规护肝降酶治疗对转归无显著影响。     

Respiratory syncytial virus protects against the subsequent development of ovalbumin‐induced allergic responses by inhibiting Th2‐type γδ T cells

Respiratory syncytial virus (RSV) infection has been hypothesized to be a risk factor for the development of allergy and asthma, but epidemiologic studies in humans still remain inconclusive. The association between RSV infection and allergic diseases may be dependent on an atopic background and previous history of RSV infection. It has been reported that RSV infection before sensitization to an allergen decreased the production of Th2‐like cytokines in the lung and the levels of allergen‐specific Th2‐type antibodies in the serum. However, the underlying mechanisms are largely unknown. In the present study, the role of pulmonary γδ T cells in RSV‐affected, allergen‐induced airway inflammation was investigated. BALB/c mice were sensitized to or challenged with ovalbumin (OVA) and infected with RSV either before or after the sensitization period. It became clear that sensitization and challenge of mice with OVA induced a large influx of γδ T cells to the lungs. However, prior RSV infection inhibited the infiltration of γδ T cells as well as activated γδ T cells, characterized by expression of CD40L or CD69 molecular in the cell surface. Moreover, prior RSV infection elevated the type 1 cytokine gene expression but suppressed type 2 cytokine expression in the lung γδ T cells. Adoptive transfer of γδ T cells from OVA‐sensitized and challenged mice increased airway inflammation, suggesting that γδ T cells may play a proinflammatory role in allergic responses. These results described here support the idea of an unknown γδ T cell‐dependent mechanism in the regulation of RSV‐affected, allergen‐induced allergic airway responses. J. Med. Virol. 85:149–156, 2012. © 2012 Wiley Periodicals, Inc.     

Detection of multiple viral and bacterial infections in acute exacerbation of chronic obstructive pulmonary disease: A pilot prospective study

Few studies have evaluated the contribution of multiple virus and bacterial infections in acute exacerbation of chronic obstructive pulmonary disease. This study estimated the burden of multiple viral and bacterial respiratory infections in moderate to very severe chronic obstructive pulmonary disease patients that were prospectively followed‐up during a 12‐month pilot study. Clinical data were collected monthly and sputum was collected at the time of each acute exacerbation event. Classical culture techniques for bacteria and multiplex polymerase chain reaction (PCR) and microarray detection assays were performed to identify viral and atypical bacterial pathogens in the sputum. Overall, 51 patients were included and 45 acute exacerbation events were investigated clinically and microbiologically. Among the 45 acute exacerbation events, 44% had evidence of viral infection involving human rhinovirus (HRV) and metapneumovirus (hMPV) in 20% and 18%, respectively. Intracellular bacteria were not found in sputum by PCR. Common bacterial pathogens were identified in 42% of acute exacerbation patients, most frequently Branhamella catarrhalis, Streptococcus pneumoniae and Haemophilus influenzae. Viral or virus and bacteria co‐infections were detected in 27% of acute exacerbation events (n = 12) with HRV and hMPV involved in 92% of cases. Patients with co‐infections did not present greater clinical severity scores at exacerbation and more recurrence of acute exacerbation events at 3 and 6 months than those with single infections (P > 0.4). These results suggest that HRV and hMPV may be contributors or cofactors of AECOPD. These findings indicate that viral or virus and bacterial co‐infections do not impact significantly on the clinical severity of acute exacerbation of chronic obstructive pulmonary disease and recurrence at 3 and 6 months. J. Med. Virol. 85:866–873, 2013. © 2013 Wiley Periodicals, Inc.     

Concurrent detection of other respiratory viruses in children shedding viable human respiratory syncytial virus

Human respiratory syncytial virus (HRSV) is an important cause of respiratory disease. The majority of studies addressing the importance of virus co‐infections to the HRSV‐disease have been based on the detection of HRSV by RT‐PCR, which may not distinguish current replication from prolonged shedding of remnant RNA from previous HRSV infections. To assess whether co‐detections of other common respiratory viruses are associated with increased severity of HRSV illnesses from patients who were shedding viable‐HRSV, nasopharyngeal aspirates from children younger than 5 years who sought medical care for respiratory infections in Ribeirão Preto (Brazil) were tested for HRSV by immunofluorescence, RT‐PCR and virus isolation in cell culture. All samples with viable‐HRSV were tested further by PCR for other respiratory viruses. HRSV‐disease severity was assessed by a clinical score scale. A total of 266 samples from 247 children were collected and 111 (42%) were HRSV‐positive. HRSV was isolated from 70 (63%), and 52 (74%) of them were positive for at least one additional virus. HRSV‐positive diseases were more severe than HRSV‐negative ones, but there was no difference in disease severity between patients with viable‐HRSV and those HRSV‐positives by RT‐PCR. Co‐detection of other viruses did not correlate with increased disease severity. HRSV isolation in cell culture does not seem to be superior to RT‐PCR to distinguish infections associated with HRSV replication in studies of clinical impact of HRSV. A high rate of co‐detection of other respiratory viruses was found in samples with viable‐HRSV, but this was not associated with more severe HRSV infection. J Med. Virol. 85:1852–1859, 2013. © 2013 Wiley Periodicals, Inc.

     

Respiratory virology and microbiology in intensive care units: a prospective cohort study

Our aim was to determine the frequency of 12 common respiratory viruses in patients admitted to intensive care units with respiratory symptoms, evaluate the clinical characteristics and to compare the results to routine microbiological diagnostics. Throat swabs from 122 intensive care‐patients >18 years with acute respiratory symptoms were collected upon admission and analysed with multiplex real‐time polymerase chain reaction, for 12 community respiratory viruses. Blood and respiratory tract specimens were analysed for bacteria and fungi upon clinicians' request. Clinical and paraclinical data were collected. Viruses were detected in 19 (16%) of the 122 study patients. Five virus‐positive patients (26%) had possible clinically relevant bacteria or fungi co‐detected. Patients with exacerbation in COPD were associated with a viral infection (p = 0.02). Other comorbidities, clinical and paraclinical parameters, and death were independent of a viral infection or co‐detection of bacteria/fungi. In conclusion, respiratory viruses were frequently detected in the patients. The investigated clinical and paraclinical parameters were not different in viral infections compared to other agents, thus respiratory viruses likely have similar impact on the clinical course as other agents. In 25% of the virus‐positive patients, polymicrobial aetiology was identified. Comprehensive and sensitive diagnostic methods should be emphasized to enhance respiratory diagnostics.     

肺超声评分评估新生儿呼吸窘迫综合征及预后的价值

目的分析新生儿呼吸窘迫综合征(NRDS)的肺超声图像特点,以及肺超声评分(LUS)对NRDS病情评估的可行性。方法选取我院早产儿病房收治的80例NRDS患儿为观察组,根据病症严重程度分为非危重组(26例)、危重组(34例)和极危重组(20例);同时期收治的非肺部疾病的早产儿60例为对照组。分别对两组治疗前行肺部超声检查,比较两组LUS的差异,观察组治疗后72 h行超声复查,比较治疗前后LUS的差异。结果1)NRDS组肺部超声主要表现为肺实变、胸膜线异常、A线模糊或消失、胸腔积液、白肺及肺搏动减弱或消失等;2)观察组LUS明显高于对照组,差异有统计学意义(P<0.05);极危重组LUS明显高于危重组,危重组LUS明显高于非危重组,组间LUS比较差异有统计学意义(P<0.05);3)NRDS组治疗72 h后,肺实变及支气管充气征减轻,胸膜线清晰光滑,A线逐渐出现,LUS较治疗前明显减低,差异有统计学意义(P<0.05)。结论NRDS以早产儿多见,具有发病急、进展快的特点,对患儿行LUS可有效评估病情的严重程度,有重要的临床意义。