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病毒感染对间质性肺病急性加重患者预后的影响

花匠小妙招
2024-11-30 19:14

摘要: 目的分析间质性肺病急性加重(AE-ILD)患者的病毒感染情况及对预后的影响。方法选择2021年3月—2023年6月徐州医科大学附属医院呼吸与危重症医学科收治的107例AE-ILD患者为研究对象。通过宏基因组二代测序(mNGS)技术对患者的血液、痰液及支气管肺泡灌洗液标本进行病毒检测。分析患者病毒感染情况及影响患者预后的危险因素。结果共88例AE-ILD患者检出病毒感染,占比为82.24%,其中EB病毒检出率最高,占AE-ILD患者的56.07%。AE-ILD患者病毒阳性组与阴性组的性别、年龄、降钙素原(PCT)、脑利尿钠肽(BNP)、乳酸脱氢酶(LDH)、氧合指数、入住重症监护室(ICU)及90 d死亡例数比较,差异有统计学意义(P<0.05)。与AE-ILD患者病毒感染存活组相比,死亡组患者更易感染人类疱疹病毒1型(HHV-1,χ2=6.180,P=0.013)及HHV-7(χ2=8.552,P=0.003)。多因素logistics回归分析显示,感染HHV-7(OR: 5.528,95%CI:1.335~22.886,P=0.018)及高LDH(OR:1.005,95%CI:1.000~1.009,P=0.031)是AE-ILD患者预后不佳的独立危险因素。结论 EB病毒是AE-ILD患者病毒感染最常见的类型。感染HHV-7及高LDH是AE-ILD患者预后不良的危险因素。

Abstract: Objective To analyze the prevalence of viral infections in patients with acute exacerbation of interstitial lung disease (AE-ILD) and their impact on prognosis. Methods A total of 107 patients with AE-ILD, who were admitted to Department of Respiratory and Critical Care Medicine at the Affiliated Hospital of Xuzhou Medical University from March 2021 to June 2023, were selected for this study. Viral detection was performed on blood, sputum, and bronchoalveolar lavage fluid samples using metagenomic next-generation sequencing (mNGS). The prevalence of viral infections and the risk factors affecting patient prognosis were analyzed. Results Among the AE-ILD patients, 88 patients (82.24%) tested positive for viral infections, with the highest detection rate observed for Epstein-Barr virus (EBV), accounting for 56.07% of AE-ILD patients. Statistically significant differences were found between the virus-positive and virus-negative groups in terms of gender, age, procalcitonin (PCT), brain natriuretic peptide (BNP), lactate dehydrogenase (LDH), oxygenation index, intensive care unit (ICU) admission cases, and 90-day mortality (P<0.05). The mortality group was more prone to infection with human herpesvirus 1 (HHV-1, χ2=6.180, P=0.013) and HHV-7 (χ2=8.552, P=0.003) than the survival group. Multivariate regression logistic analysis indicated that infection with HHV-7 (OR: 5.528, 95%CI: 1.335-22.886, P=0.018) and elevated LDH levels (OR: 1.005, 95%CI: 1.000-1.009, P=0.031) were independent risk factors for poor prognosis in AE-ILD patients. Conclusions EBV is the most common type of viral infection in AE-ILD patients. Infection with HHV-7 and high LDH levels are risk factors for poor prognosis in AE-ILD patients.

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