Mecit SÜERDEM, Duygu FINDIK, Burcu YORMAZ

KOAH alevlenmeli hastalarda gerçek zamanlı PCR tekniğiyle viral panel pozitif olanların negatif olanlardan farklılığı

Giriş: Kronik obstrüktif akciğer hastalığı (KOAH)'nın alevlenmesi genellikle solunum yolu infeksiyonlarından kaynaklanır. Bu çalışmanın amacı, gerçek zamanlı polimeraz zincir reaksiyonu (PCR) tekniği kullanılarak solunum yolu virüslerinin tespit edildiği hastane yatışı olan KOAH alevlenmeli hastaların klinik, laboratuvar ve bilgisayarlı tomografi özelliklerini araştırmaktı. Materyal ve Metod: Retrospektif olarak planlanan bu çalışmaya, Kasım 2018-Şubat 2019 tarihleri arasında KOAH alevlenmesi nedeniyle göğüs hastalıkları kliniğinde yatan hastalar alındı. Çalışma, virüse özgü gerçek zamanlı PCR tekniği ile viral panel bakılmış ve akciğer tomografisi olan hastaları içermektedir. Bulgular: Toplam 110 hasta çalışmaya dahil edildi. Elli hastanın (%45.5) nazofarengeal sürüntülerinde solunum virüsleri, gerçek zamanlı PCR yöntemi kullanılarak tanımlandı, rinovirüs (%25), influenza A (%13.1) ve coronavirüs (%11.8) en sık izole edilen ajanlardı. Hastaların yaş ortalaması virüs pozitif grupta 68.28 ± 9.59 ve virüs negatif grupta 68.20 ± 8.27 (p= 0.963) idi. Cinsiyet dağılımı, sigara içenlerin oranı, biyoyakıt maruziyeti, kan lökosit sayısı, nötrofil yüzdesi, C-reaktif protein (CRP) düzeyi, FEV1/FVC oranı bakımından iki grup arasında anlamlı fark görülmedi (p> 0.05). Virüs pozitif grupta, Prokalsitonin (PCT) ve FEV1 değerleri anlamlı derecede düşüktü (sırasıyla p= 0.001 ve p= 0.028) ve alevlenme sayısı anlamlı olarak daha yüksekti (p= 0.001). Hastanede kalış süresi virüs pozitif grupta virüs negatif gruptan daha uzundu (p= 0.012). Bilgisayarlı tomografi (BT), bronş duvarı kalınlaşması, kistik bronşektazi ve amfizem bulguları arasında anlamlı fark bulunmadı (p> 0.05). Virüs pozitif grupta infiltratif lezyonların oranı (tomurcuklanmış ağaç opasitesi, buzlu cam opasitesi, atipik pnömoni) anlamlı olarak yüksekti (p= 0.020). Sonuç: Sık alevlenme öyküsü mevcut, normal PCT değeri olan ve göğüs tomografisinde konsolidasyon bulunmayan KOAH alevlenme nedeniyle hastane yatışı olan hastalarda viral solunum yolu infeksiyonları düşünülmelidir. Bu özelliklere sahip hastalarda geniş spektrumlu antibiyotik tedavisi kullanmaktan kaçınılmalıdır.

Differences of viral panel positive versus negative by real-time PCR in COPD exacerbated patients

Introduction: Exacerbations of chronic obstructive pulmonary disease(COPD) are often caused by respiratory tract infections. The aim of this studywas to investigate the clinical, laboratory and computed tomography featuresof patients with hospitalized COPD exacerbations in which respiratory viruseswere detected using a real-time polymerase chain reaction (PCR) technique.Materials and Methods: This retrospectively planned study included patientshospitalized in the chest diseases clinic due to exacerbation of COPDbetween November 2018-February 2019. The study included patients whohad virus-specific real-time PCR, and computed tomography scans of thechest.Results: A total of 110 patients were included in the study. Respiratory viruseswere identified in the nasopharyngeal swabs of 50 patients (45.5%) using thereal-time PCR method, with rhinovirus (25%), influenza A (13.1%) andcoronavirus (11.8%) being the most commonly isolated agents. The meanage of the patients was 68.28 ± 9.59 years in the virus-positive group and68.20 ± 8.27 years in the virus-negative group (p= 0.963). Genderdistribution, rate of smokers, exposure to biofuels, blood leukocyte count,neutrophil percentage, C-reactive protein (CRP) level, FEV1/FVC ratio did notsignificantly differ between the two groups (p> 0.05). Procalcitonin (PCT) andFEV1 values were significantly lower (p= 0.001 and p= 0.028, respectively)and the number of exacerbations was significantly higher in the virus-positivegroup (p= 0.001). The length of hospital stay was longer in the virus-positivegroup than in the virus-negative group (p= 0.012). Among the findings ofcomputed tomography (CT) of the chest, bronchial wall thickening, cysticbronchiectasis, and emphysema did not differ significantly (p> 0.05). The rate of infiltrative lesions (tree-in-bud opacity, ground-glassopacity, atypical pneumonia) was significantly higher in the virus-positive group (p= 0.020).Conclusion: Viral respiratory tract infections should be considered in hospitalized patients with an exacerbation of COPD who havea history of frequent exacerbations, normal PCT value, and the absence of consolidation in CT scan of the chest. The use of broadspectrum antibiotic therapy should be avoided in patients with these features.

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