恶性血液病患者合并呼吸道感染的病毒病原学分析

宗慧君; 张齐; 杨阳; 尚学义; 王鑫; 李艳

doi:10.12435/j.issn.2095-5227.2023.061

恶性血液病患者合并呼吸道感染的病毒病原学分析

Viral etiology of respiratory tract infection in patients with hematologic malignancy

摘要

摘要:
背景恶性血液病患者由于免疫力低下，极易并发呼吸道病毒感染，而临床医师容易忽视此类感染。
目的探讨恶性血液病患者合并呼吸道感染的病毒病原学特点。
方法收集2018年10月 - 2020年1月入住解放军总医院第五医学中心的442例呼吸道感染患者咽拭子标本，并记录临床资料。其中229例为恶性血液病合并呼吸道感染患者，213例为单纯呼吸道感染患者。应用实时荧光定量PCR方法对所收集的咽拭子标本进行呼吸道病毒核酸检测，包括8种病毒：流感病毒(influenza virus，IFV)、副流感病毒(parainfluenza virus，PIV)、呼吸道合胞病毒(respiratory syncytial virus，RSV)、偏肺病毒(metapneumovirus，MPV)、人博卡病毒(human bocavirus，HBoV)、腺病毒(adenovirus，ADV)、人冠状病毒(human coronavirus，HCoV)和鼻病毒(rhinovirus，HRV)。
结果恶性血液病合并呼吸道感染患者的病毒阳性率(48.03% vs 34.27%，P=0.003)和病毒载量(29.65 ± 4.07 vs 31.51 ± 3.58，P＜0.001)显著高于单纯呼吸道感染患者。恶性血液病合并呼吸道感染患者病毒阳性率依次为IFV(14.85%)、RSV(12.66%)、HRV(5.68%)、HCoV(3.49%)、MPV(3.06%)、PIV(2.18%)、ADV(0.87%)和HBoV(0)。不同恶性血液病病毒阳性患者白细胞(white blood cell， WBC)与淋巴细胞计数(lymphocyte count，LYM)均有所下降，其中急性髓系白血病(acute myeloid leukaemia，AML)患者LYM下降更为显著Md(IQR)：0.77(0.36 ~ 1.23) × 10⁹/L vs 1.08(0.63 ~ 1.60) × 10⁹/L，P=0.037。
结论恶性血液病合并呼吸道感染患者的病毒易感性显著高于单纯呼吸道感染患者，以IFV、RSV和HRV感染为主；AML患者中，呼吸道病毒阳性者LYM较阴性者更低。

Abstract:
Background Patients with hematological malignancies are prone to complicate respiratory viral infections due to low immunity, and clinicians are prone to ignore such infections.
Objective To investigate the viral etiological characteristics of respiratory tract infection in patients with hematological malignancies.
Methods Throat swab specimens were collected from 442 patients with respiratory infections admitted to the Fifth Medical Center of Chinese PLA General Hospital from October 2018 to January 2020, and clinical data were recorded. The sample included 229 patients with hematological malignancies complicated by respiratory infections and 213 patients with respiratory infections alone. The collected throat swab samples were tested for respiratory viral nucleic acids by real-time PCR for eight viruses: influenza virus (IFV), parainfluenza virus (PIV), respiratory syncytial virus (RSV), metapneumovirus (MPV), human bocavirus (HBoV), adenovirus (ADV), human coronavirus (HCoV) and rhinovirus (HRV).
Results The viral positive rate (48.03% vs 34.27%, P=0.003) and viral load (29.65 ± 4.07 vs 31.51 ± 3.58, P＜0.001) in the patients with hematological malignancies complicated by respiratory infection were significantly higher than those in the patients with respiratory infection alone. The viral positive rates from high to low in patients with hematologic malignancies and respiratory infections ranked as IFV (14.85%), RSV (12.66%), HRV (5.68%), HCoV (3.49%), MPV (3.06%), PIV (2.18%), ADV (0.87%), and HBoV (0.00%). White blood cell (WBC) and lymphocyte count (LYM) decreased in patients positive for different hematological malignancies, especially in patients with acute myeloid leukemia (AML) (0.77 0.36, 1.23 × 10⁹/L vs 1.08 0.63,1.60 × 10⁹/L, P=0.037).
Conclusion The susceptibility of patients with hematological malignancies complicated with respiratory infection is significantly higher than that of patients with respiratory infection alone, mainly with IFV, RSV and HRV infections. AML respiratory virus-positive patients have a lower LYM than negative patients.

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