Respiratory syncytial virus, airway inflammation, and FEV1 decline in patients with chronic obstructive pulmonary disease
Respiratory syncytial virus, airway inflammation, and FEV1 decline in patients with chronic obstructive pulmonary disease
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DOI：
10.1164/rccm.200509-1489oc
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发表时间：
2006-04-15
影响因子：
24.7
通讯作者：
Wedzicha, JA
中科院分区：
文献类型：
--
作者：
Wilkinson, TMA;Donaldson, GC;Wedzicha, JA
背景：呼吸道合胞病毒(RSV)是成人心肺疾病的重要病原体。它与慢性阻塞性肺疾病(COPD)的急性加重有关；然而，它也在稳定状态的下呼吸道中被检测到，但先前还没有确定RSV在稳定疾病中的后果。因此，我们研究了呼吸道合胞病毒在成人COPD患者中持续存在的后果及其对呼吸道炎症和肺功能下降的影响。方法：收集74例COPD患者的241份痰标本(FEV1%预测值，39.2%；四分位数范围，29.6-57.8%)，在稳定状态下每季度收集一次。用聚合酶链式反应(PCR)检测呼吸道合胞病毒(RSV)，进行定量微生物学检测，用ELISA法定量检测炎性细胞因子。结果：32.8%的痰标本中检出RSV RNA。呼吸道合胞病毒检测更频繁的患者(50%的样本呼吸道合胞病毒聚合酶链式反应阳性，n=18)在研究期间(101.4毫升/年[95%可信区间，57.1-145.8])比呼吸道合胞病毒检测较少的患者(n=56；51.2ml/年[31.7-70.8]；p=0.01)有更高的呼吸道炎症和更快的FEV1下降。结论：慢性阻塞性肺疾病患者持续的呼吸道合胞病毒检测与呼吸道炎症和FEV1加速下降有关。慢性呼吸道合胞病毒感染可能是改变COPD自然病程的一个新的治疗靶点。
Background: Respiratory syncytial virus (RSV) is increasingly recognized as an important pathogen in adults with cardiopulmonary disease. It has been associated with acute exacerbations of chronic obstructive pulmonary disease (COPD); however, it has also been detected in the lower airway in the stable state, but the consequences of RSV in stable disease have not previously been determined. We therefore studied the consequences of RSV persistence in adults with COPD and its effect on airway inflammation and lung function decline.Methods: A total of 241 sputum samples from 74 patients with COPD (FEV1% predicted, 39.2%; interquartile range, 29.6-57.8%) were collected quarterly in the stable state over 2 yr. RSV was detected by polymerase chain reaction (PCR), quantitative microbiology was performed, and inflammatory cytokines were quantified by ELISA.Results: RSV RNA was detected in 32.8% of sputum samples. Patients in whom RSV was more frequently detected (> 50% of samples RSV PCR-positive, n = 18) had higher airway inflammation and faster FEV1 decline over the study (101.4 ml/yr [95% confidence interval, 57.1-145.8]) compared with those with less frequent detection of RSV (n = 56; 51.2 ml/yr [31.7-70.8]; p = 0.01). The observed relationship between RSV detection and accelerated lung function decline was independent of smoking status, exacerbation frequency, and lower airway bacterial load.Conclusions: Persistent RSV detection in patients with COPD is associated with airway inflammation and accelerated decline in FEV1. Chronic RSV infection may be a novel therapeutic target to alter the natural history of COPD.