CAJ | 학술논문

目的分析评价采用流感病毒快速检测法诊治流感的应用价值.方法前瞻性选择2007年12月-2008年3月流感季节在北京朝阳医院发热门诊就诊的符合卫生部流感样病例患者500例,留取咽部分泌物进行流感病毒培养,随机选取260例患者进行流感病毒快速检测,并调查患者性别、年龄、症状、实验室检查、症状恢复时间、治疗花费等因素.同时分析流感病毒培养阳性组与流感病毒快速检测组的敏感度、特异度、阳性预测值和阴性预测值,及对治疗方案和预后的影响.结果 2007-2008年流感季节共入选流感样病例500例,最终498例纳入分析,病毒培养结果主要为乙型流感(208例,41.8%),而甲型流感少见(51例,10.2%).498例流感样患者的平均年龄为35岁,男:女比例为1.47:1.与培养阴性组比较,培养阳性组咳嗽、咽痛、鼻塞症状比例比较高(t值分别为13.728、4.014和4.720,P均<0.01或0.05).260例经流感病毒快速检测患者中,甲型流感抗原阳性18例、乙型流感抗原阳性132例,流感病毒快速检测的敏感度77.1%、特异度70.1%、阳性预测值78.6%、阴性预测值68.2%.流感病毒快速检测抗病毒治疗的比例由0提高到26%,抗生素使用比例由63.4%降到20.7%.结论 2007-2008年流感季节主要流感类型为乙型流感,流感病毒快速检测法对临床病例检测敏感度和特异度较高,对临床抗病毒诊治有指导意义.
목적 분석평개채용류감병독쾌속검측법진치류감적응용개치.방법 전첨성선택2007년12월-2008년3월류감계절재북경조양의원발열문진취진적부합위생부류감양병례환자500례,류취인부분비물진행류감병독배양,수궤선취260례환자진행류감병독쾌속검측,병조사환자성별、년령、증상、실험실검사、증상회복시간、치료화비등인소.동시분석류감병독배양양성조여류감병독쾌속검측조적민감도、특이도、양성예측치화음성예측치,급대치료방안화예후적영향.결과 2007-2008년류감계절공입선류감양병례500례,최종498례납입분석,병독배양결과주요위을형류감(208례,41.8%),이갑형류감소견(51례,10.2%).498례류감양환자적평균년령위35세,남:녀비례위1.47:1.여배양음성조비교,배양양성조해수、인통、비새증상비례비교고(t치분별위13.728、4.014화4.720,P균<0.01혹0.05).260례경류감병독쾌속검측환자중,갑형류감항원양성18례、을형류감항원양성132례,류감병독쾌속검측적민감도77.1%、특이도70.1%、양성예측치78.6%、음성예측치68.2%.류감병독쾌속검측항병독치료적비례유0제고도26%,항생소사용비례유63.4%강도20.7%.결론 2007-2008년류감계절주요류감류형위을형류감,류감병독쾌속검측법대림상병례검측민감도화특이도교고,대림상항병독진치유지도의의.
Objective To analyze the application value of the rapid testing for influenza during 2007-2008 flu season at fever clinic in Beijing Chaoyang hospital Methods 500 patients with diagnosis of influenza-like illness were prospectively enrolled. Pharyngeal swabs were collected for influenza viral culture and rapid testing for influenza. Demographic characteristics, age, symptoms, lab tests, symptom recovery time and medical expense were also collected. The sensitivity, specificity, positive predictive value and negative predictive value for rapid testing were analyzed. Results A total of 500 patients were enrolled between Dec 2007 and March 2008. Among them 498 cases were used for analysis. Influenza B was most common by virus culture methed(n=208,41.8%) ,followed by influenza A (n=51,10.2%). The average age was 35, and the ratio of male to female was 1.47:1. Compared with the group of positive culture, patients with influenza were more likely to get cough, sore throat, and nasal congestion (t=13.728, 4.014and 4.720,P<0.001 or 0.05, respectively). A total of 260 cases were subjected to rapid testing, Among them 18 cases were influenza A positive and 132 cases were influenza B positive. The rapid testing had a sensitivity of 77.1 % and a specificity of 70.1%. The positive predictive value was 78.6% and the negative predictive value was 68.2%. The rapid testing had enhanced the proportion of anti-viral treatment from 0 to 26% and reduced the proportion of antibiotic use from 63.4% to 20. 7%. Conclusions Influenza B is the most predominant pathogen during 2007-2008 flu season among patients with influenza-like illness in Beijing. The rapid testing with high sensitivity and specificity provides guidance on clinical practice.