Study On Respiratory Virus Infection In Acute Exacerbations Of Chronic Obstructive Pulmonary Disease And Risk Assessment Of Acute Exacerbation

Objective: To investigate the characteristics of respiratory viral infections,and correlation between inflammatory cytokines and respiratory virus infections in patients with acute exacerbations of chronic obstructive pulmonary disease(COPD).and to evaluate the related factors of the risk of acute exacerbations.Methods: A prospective cohort of patients with acute exacerbations of COPD.The sputum of all patients were collected,and 15 respiratory viruses were detected using multi-channel real-time fluorescence quantitative PCR,the clinical characteristics associated with viral infections were analyzed.Collect the peripheral blood of the patients and detect the cytokines including IL-6,IL-8,RANTES,IP-10,sIL-2R,IFN-γ,TNF-α in the serum by ELISA.Association of these cytokines with respiratory viral infections were evaluated.And a discriminant model was established.All patients were stratified by risk of exacerbation,and the related factors of the risk were further explored.Results: A total of 99 patients with acute exacerbations of COPD were enrolled in this study.34 cases(34.3%,34/99)were positive for virus detection.Among them,the positive rate of influenza A virus was the highest(38.2%,13/34),followed by rhinovirus(35.3%,12/34).Multifactor Logistic regression analysis showed that,fever,CAT score in stable stage,serum IP-10 and TNF-α levels were correlated with respiratory viral infection in patients with acute exacerbations of COPD.The levels of serum IP-10 and sIL-2R increased significantly in patients with influenza A virus.Infection with respiratory viruses,usual use of ICS and NT-proBNP grouping were related factors of the risk of acute exacerbations.Conclusion: Respiratory viral infections are common in acute exacerbations of COPD,rhinovirus and influenza A virus are the two most common viruses.Fever is a common symptom.Patients with severe respiratory symptoms at stable stage are susceptible to virus.Viral infections lead to an increase in systemic inflammatory level,and influenza virus is the significant.Discriminant model composed of fever,CAT score in stable stage,serum IP-10 and TNF-α levels can be used to distinguish respiratory viral infections in acute exacerbations of COPD.Patients with higher risk of acute exacerbation need to use ICS at stable stage,are susceptible to respiratory virus,and have higher risk of heart failure in acute exacerbations.