ICU脓毒症患者潜伏性病毒携带状况分析

Opportunistic latent virus carrying status in ICU sepsis patients

  • 摘要: 目的 调查北京大学航天临床医学院重症医学科脓毒症患者血液标本中潜伏性病毒的携带状况,结合患者临床资料,分析脓毒症患者携带病毒的种类分布及其与患者病情发展及转归的关系,为临床脓毒症患者早期抗病毒治疗提供参考。 方法 选取2017年1月-2018年1月在北京大学航天临床医学院重症医学科收治的脓毒症患者为观察组,同期收治的非脓毒症患者为阴性对照组,收集静脉血标本进行PCR检测,结合病毒检出结果对脓毒症患者病情变化及转归进行分析。 结果 纳入脓毒症患者61例,非脓毒症患者61例。所有患者共检出6类病毒,包括巨细胞病毒(cytomegalovirus,CMV)19例(15.6%),EB病毒(Epstein-Barr virus,EBV)39例(31.9%),单纯疱疹病毒(herpes simplex virus,HSV)10例(8.1%),人疱疹病毒6型(human herpes virus 6,HHV-6)9例(7.3%),风疹病毒(rubella virus,RuBV)7例5.7%,腺病毒(adenovirus,AdV)2例(1.6%)。脓毒症组中CMV (21.3% vs 9.8%)、EBV (47.5% vs 13.1%)和RuBV (8.2% vs 3.3%)的检出率高于非脓毒症组(P均< 0.05),脓毒症组中同时检出两种及以上病毒种类的患者比例也高于非脓毒症组(42.6% vs 6.6%,P=0.01)。在脓毒症组中,CMV检出阳性的脓毒症患者平均住院时间长于CMV阴性的患者(19.76±4.21 vs 17.22±3.66,P=0.03)。EBV阳性的脓毒症患者平均住院时间长于检出阴性的患者(26.02±5.27 vs 20.11±4.06,P=0.01),死亡率也高于阴性患者(49.1% vs 36.6%,P=0.01)。 结论 ICU脓毒症患者潜伏性病毒检出率高于非脓毒症患者。脓毒症患者血标本潜伏性病毒以CMV和EBV多见。CMV和EBV检出阳性患者平均住院时间长、死亡率高。

     

    Abstract: Objective To explore the latent virus carrying in patients with sepsis, and analyze the relationship between latent viral distribution and outcomes in sepsis patients so as to provide evidence for early antiviral treatment. Methods Patients with sepsis treated in ICU of the Peking University Areospace School of Clinical Medicine from January 2017 to January 2018 were enrolled in the experimental group, non septic patients matched by age and sex in the same period served as the control group. Venous blood samples were collected for PCR detection. The virus carrying status was compared between two groups, and the prognosis of sepsis patients was analyzed. Results Sixty-one patients with sepsis and 61 cases of non sepsis patients were included in this study. Six virus strains were detected, including CMV (19, 15.6%), EBV (39, 31.9%), HSV (10, 8.1%), HHV (9, 7.3%), RuBV (7, 5.7%), AdV(2, 1.6%). The proportion of patients with positive virus in sepsis was higher than that of non sepsis group. The positive rates of CMV(21.3% vs 9.8%), EBV (47.5% vs 13.1%) and RuBV (8.2% vs 3.3%) in the sepsis group were higher than those in non-sepsis group(all P< 0.05). The proportion of patients with two or more types of virus in the sepsis group was also higher than non-sepsis group.In the sepsis group, the positive rate of virus detection increased as the duration of continuous hospitalization prolonged. Among the sepsis patients, the average length of hospital stay was longer in patients detected positive of CMV and EBV than negative patients(19.76±4.21) d vs (17.22±3.66) d; (26.02±5.27) d vs (20.11±4.06) d, P< 0.05, respectively. The mortality rate of EBV positive patients with sepsis was higher than that of negative patients (49.1% vs 36.6%, P< 0.01). Conclusion The detection rate of latent virus in ICU sepsis patients is higher than that in non-septic patients. CMV and EBV are the most common seen strains.

     

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