Incidence and clinical impact of respiratory viruses in adults with cystic fibrosis
Incidence and clinical impact of respiratory viruses in adults with cystic fibrosis
复制标题
DOI：
10.1136/thoraxjnl-2013-204000
复制
发表时间：
2014-03-01
期刊：
影响因子：
10
通讯作者：
Jones, Andrew M.
中科院分区：
文献类型：
--
作者：
Flight, William G.;Bright-Thomas, Rowland J.;Jones, Andrew M.
背景：病毒性呼吸道感染（VRI）是囊性纤维化（CF）患儿肺部恶化的常见原因。VRI在成年CF人群中的重要性尚不清楚。目的了解成人CF患者VRI的发生率及临床影响。方法对100例成人CF患者进行为期12个月的前瞻性随访。痰液、鼻拭子和咽拭子每2个月及在肺加重发作时采集一次。对每个样本进行腺病毒、甲型和乙型流感、人偏肺病毒、副流感1-3、呼吸道合胞病毒和人鼻病毒的PCR检测。每次就诊均测量症状评分、肺活量测定和炎症标志物。结果626例患者中有191例（30.5%）检出一种或多种呼吸道病毒。人鼻病毒占病毒总数的72.5%。VRI的总发病率为1.66例/患者年（95% CI 1.39 ~ 1.92）。VRI与肺恶化风险增加（OR=2.19; 95% CI 1.56 ~ 3.08; p<0.001）和抗生素处方（OR=2.26; 95% CI 1.63 ~ 3.13; p<0.001）相关。病毒阳性就诊与较高的呼吸症状评分和较高的c反应蛋白水平相关。病毒阳性加重组的fev1急性下降低于病毒阴性加重组（12.7% vs 15.6%; p=0.040）。在12个月内，急性加重的发生率，而非VRI，与肺功能更大的下降相关（每次肺加重/年- 1.79%;95% CI - 3.4至- 0.23;p=0.025）。结论vri在成年CF患者中很常见，且发病率较高。呼吸道病毒是CF肺病的潜在治疗靶点。
BackgroundViral respiratory infection (VRI) is a common cause of pulmonary exacerbations in children with cystic fibrosis (CF). The importance of VRI in adult CF populations is unclear.ObjectiveTo determine the incidence and clinical impact of VRI among adults with CF.MethodsOne hundred adults with CF were followed up prospectively for 12 months. Sputum, nose swabs and throat swabs were collected every 2 months and at onset of pulmonary exacerbation. PCR assays for adenovirus, influenza A&B, human metapneumovirus, parainfluenza 1–3, respiratory syncytial virus and human rhinovirus were performed on each sample. Symptom scores, spirometry and inflammatory markers were measured at each visit.ResultsOne or more respiratory viruses were detected in 191/626 (30.5%) visits. Human rhinovirus accounted for 72.5% of viruses. Overall incidence of VRI was 1.66 (95% CI 1.39 to 1.92) cases/patient-year. VRI was associated with increased risk of pulmonary exacerbation (OR=2.19; 95% CI 1.56 to 3.08; p<0.001) and prescription of antibiotics (OR=2.26; 95% CI 1.63 to 3.13; p<0.001). Virus-positive visits were associated with higher respiratory symptom scores and greater C-reactive protein levels. Virus-positive exacerbations had a lower acute fall in FEV1than virus-negative exacerbations (12.7% vs 15.6%; p=0.040). The incidence of exacerbations, but not VRI, was associated with greater lung function decline over 12 months (−1.79% per pulmonary exacerbation/year; 95% CI −3.4 to −0.23; p=0.025).ConclusionVRI is common in adults with CF and is associated with substantial morbidity. Respiratory viruses are a potential therapeutic target in CF lung disease.