The Research Of Relationship Between Respiratory Syncytial Virus (rsv) Infection And Airway Inflammation Of The Stable Patients With Chronic Obstructive Pulmonary Disease

Background:Chronic obstructive pulmonary disease (COPD) is a kind of disease characterized by non-fully reversible airflow limitation. The current incidence and prevalence of COPD is rising. By 2020, it will become the world's third leading cause of death. Chronic airway inflammation is the main pathogenesis for COPD. As is known to all, infection and smoking in COPD patients with persistent airway inflammation plays an important role in the process, and this can lead to the deterioration of lung function in patients with COPD and accelerate the progression of the disease. For a long time, few studies have been carried to the relationship between respiratory virus infection and COPD, and such studies have been in dispute all the time.According to research, the incidence of respiratory virus infection is high, some of the virus invades the human body, then it may infringe on vital organs. And as a continuation of acute respiratory infections three kinds of situation may occur, as following:first acute or latent viral infection, the virus lurk within the organization to form a latent infection, no clinical symptoms, spurred by certain conditions the virus may be re-proliferation of acute onset; secondly, the virus chronicly exists within the organization to form a chronic infection, and constantly cause hyperplasia, and continuously discharge the virus, no clinical symptoms present in the a considerable period of time; thirdly, the virus infection form a slow-hair one, after a long incubation period, however, it result in the ensuing chronic progressive disease. Many epidemiological studies have shown that lower respiratory infections during childhood may be caused by bronchial asthma and in adults it occurred turn out to be an independent risk factor for COPD. So lower respiratory infections of viruses was a major pathogenic risk, which includes the common respiratory syncytial virus (RSV) and the adenovirus (ADV). Studies of some scholars home and abroad have shown that in the period of acute infection of adenovirus after the cessation of virus replication, adenovirus EIADNA and proteins present in the lung tissue of sustainable, mainly in bronchial epithelial cells, alveolar epithelial cells and submucosal cells. And the research also shows that ADV (double-stranded DNA virus) in COPD patients with airway inflammation, airflow obstruction in the process play an important role. The relevant RNA virus, especially the role of respiratory syncytial virus (RSV) in the COPD progression has been reported and few foreign and domestic not yet been examined.Purpose:The study is to determine through the follow-up of different levels of patierts the induced sputum in stable COPD patients to test the RSV-RNA, IL-6, IL-8, MMP-12 changes in the concentrations of RSV infection in the patients with COPD, then the relationship between airway inflammation and the RSV-RNA infaction help us understand the pathogenesis of RSV infection mechanism in COPD and the relationship between RSV infaction and the seasons, to provide for the treatment and prevention of COPD patients and the theoretical basis for opening up new ideas for the treatment COPD patients.Methods:The 80 patients selected from Respiratory Medicine hospital outpatient and inpatient services were collected, and signed the informed consent form in stable COPD patients (inclusion criteria in line with 2002, "Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease Guide" diagnostic criteria), and meet the following criteria: first with no history of bronchial asthma, inhalation of 200ug salbutamol FEV1% predicted after the reversibility of "10%; (2) the patients without severe heart, liver, kidney and other diseases; no other lung diseases were found in chest X-ray. The test groups are as follows:normal control group:20 cases of healthy controls without smoking history. There was no specific history, almost 2 months without systemic infection by physical examination, nothing unusual were found in chest X-ray and other pulmonary function test.1. Using reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) methods to measure the RSV-RNA copy number and sputum inflammatory factor IL-6, IL-8 and matrix metalloproteinase-12 (MMP-12) concentration in induced sputum; follow up every 4 months for one year, these targets were determined during each follow-up to explore the relationship between RSV infection and airway inflammation in patients with stable COPD, and then the relationship between RSV infaction and the seasons. 2. Data are as mean±standard deviation form, to be statistically analyzed.Results:(1) Selecting of patients with chronic obstructive pulmonary disease and objective indicators of airflow limitation test resultsA total of 80 patients with chronic obstructive pulmonary disease (COPD) were selected,47 cases were male,33 female, aged 43-72 years with a mean (52.33±11.07) years of age; course of 3 to 45 years, the average was (15.63±11.45) year.To the patients in each group, indicators of airflow obstruction FEV1 and FEV1/FVC values and comparison of patients were detected by routine operation of vital capacity (VC), FEV1, FEV1/FVC. The VC, FEV1 was measured as value/predicted value ratios, and the FEV1/FVC as the measured value. The test data were X±S form.For the patients of COPD group, the FEV1 of total percentage of predicted value was (69.59±26.44)%, FEV1% being (58.79±19.55), as for the control group, accounting for FEV1 percentage of predicted value was (87.23±29.11)%, FEV1% being (74.89±23.86).The airway obstruction index between the two groups was statistically significant difference (P<0.05).(2) The establishment and test results of the RSV Real Time RT-PCR detection in induced sputum.The results of respiratory viruses (RSV) in each groups of the patients, detection rates are as following:for the COPD group of patients, RSV-positive detection number was 23 cases, the detection rate was 28.75%; to the control group of patients, the RSV-positive detection was 0 cases; the difference between the two groups of RSV infection was statistically significant, the RSV detection rate of the COPD group was significantly higher than the control group (P<0.05).3. The testing results of inflammatory cytokines IL-6, IL-8 and MMP12 and other indicators of induced sputum.A total of 80 cases of chronic obstructive pulmonary disease were selected, with 47 cases male,33 female, aged 43-72 years with the mean (52.33±11.07) years; all 3 to 45 years, the average (15.63±11.45)years.To the Patients in each group induced sputum inflammatory cytokines IL-6 testing results are in Table 4, the groups of test data are X±S form, as the results shown in Table 8. COPD-RSV-positive group of induced sputum inflammatory cytokines IL-6, IL-8 and MMP12 such testing was significantly higher than COPD-RSV-negative group and control group, P<0.05.4. The follow-up experiments:each group of patients during treatment were at different stages of follow-up of inflammatory cytokines in induced sputum, the test results showed that IL-6, IL-8 and MMP12, etc were different, P<0.05. With the downward trend in the rehabilitation of illness in various subgroups of patients there were still significantly different (P<0.05) from their base on the decline. Between the different groups of airway obstruction index difference was statistically significant, while obviously different from the control group (P<0.05).5. Statistical analysis showed that RSV infection in selected patients with COPD, there is a high correlation between them, the second, third follow-up results showed that:the RSV infection rate in stable COPD patients in according groups were higher than the second one, the difference was statistically significant, P<0.05; And for the RSV infection and airway inflammation in COPD patients the correlation analysis showed that, RSV infection and induced sputum inflammatory cytokines IL-6, IL-8 and MMP12 levels were a certain correlative between the relevance of the test results P<0.05, relatively statistically significant, and this correlation in the severity of the different groups of patients have been reflected.Further correlation analysis also suggests that different seasons of the RSV infection rate was different, and the difference was statistically significant, P<0.05, the results showed that COPD patients with RSV infection rate in the winter and spring season was significantly higher than in summer and autumnConclusion:This study was aimed to reseach the different levels of induced sputum of stable COPD patients, including RSV-RNA, IL-6, IL-8, MMP-12 changes and the concentrations of RSV infection and airway inflammation in patients with COPD, the conclusion was that the respiratory syncytial virus infection and with stable COPD airway inflammation in patients with strong correlation, COPD severity of the patient's symptoms of RSV infection increases with the increase of infection ratio, and the sputum IL-6, IL-8, MMP-12 concentration of RSV-positive patients with was significantly higher, P< 0.05, and along with RSV infection rates increased, there was the stronger correlation (P<0.05). And further correlation analysis also suggests that different seasons of the RSV infection rate was different, and the difference was statistically significant, P<0.05, the results showed that COPD patients with RSV infection rate in the winter and spring season was significantly higher than in summer and autumn. In summary, RSV infection and COPD patients with airway obstruction, airway inflammation has a strong correlation. The study on the RSV infection in the COPD patients may contribute a lot to understand and guide the further treatment to the the COPD patients.