中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2010年
6期
406-410
,共5页
王晓杰%蒋荣猛%徐艳利%张伟%皇甫竞坤%王艳斌%王京京%卢联合%李宝顺%焦以庆%陈志海%郭利民%李兴旺
王曉傑%蔣榮猛%徐豔利%張偉%皇甫競坤%王豔斌%王京京%盧聯閤%李寶順%焦以慶%陳誌海%郭利民%李興旺
왕효걸%장영맹%서염리%장위%황보경곤%왕염빈%왕경경%로연합%리보순%초이경%진지해%곽이민%리흥왕
流感病毒A型,H1N1亚型%危重病%C反应蛋白%抗病毒药
流感病毒A型,H1N1亞型%危重病%C反應蛋白%抗病毒藥
류감병독A형,H1N1아형%위중병%C반응단백%항병독약
Influenza A virus,H1N1 subtype%Critical illness%C-reactive protein%Antiviral agents
目的 了解新型甲型H1N1流感(简称甲型流感)危重病例的临床特点,探讨与死亡相关的危险因素. 方法 采用前瞻性研究方法分析北京地坛医院2009年10月3日至12月15日收治的55例甲型流感危重病例的临床特点,并对存活病例和死亡病例进行比较分析. 结果 55例中男31例,女24例,年龄10个月至84岁,平均(38±20)岁.危重患者中<65岁48例(48/55),肥胖33例(33/49),伴基础疾病26例(26/49),妊娠6例(6/24),临床表现为高热、咳嗽、咳痰(部分为血痰)及呼吸困难,双肺可闻及干湿性啰音.55例中54例并发呼吸衰竭,26例并发ARDS,38例需行机械通气;27例继发感染,其中肺部感染24例(呼吸机相关肺炎10例).发病早期C反应蛋白升高,平均为(131±130)mg/L,CD4+及CD8+T细胞计数降低,分别为(217±139)/μl和(162±82)/μl;随病程进展,死亡病例的C反应蛋白持续升高,T细胞亚群计数持续降低,继发真菌感染的比例明显高于存活组(P<0.05);Logistic回归分析结果显示,体重指数高及继发真菌感染的患者病死率明显增高(OR值分别为6.512和19.631,P均<0.05);发病48 h内使用奥司他韦抗病毒治疗者中未出现死亡病例. 结论 青壮年、肥胖、伴基础疾病和妊娠的甲型流感患者易进展为危重症;C反应蛋白水平持续升高及T细胞亚群计数持续降低提示预后不良;体重指数高及继发真菌感染者病死率高;早期应用奥司他韦治疗可降低病死率.
目的 瞭解新型甲型H1N1流感(簡稱甲型流感)危重病例的臨床特點,探討與死亡相關的危險因素. 方法 採用前瞻性研究方法分析北京地罈醫院2009年10月3日至12月15日收治的55例甲型流感危重病例的臨床特點,併對存活病例和死亡病例進行比較分析. 結果 55例中男31例,女24例,年齡10箇月至84歲,平均(38±20)歲.危重患者中<65歲48例(48/55),肥胖33例(33/49),伴基礎疾病26例(26/49),妊娠6例(6/24),臨床錶現為高熱、咳嗽、咳痰(部分為血痰)及呼吸睏難,雙肺可聞及榦濕性啰音.55例中54例併髮呼吸衰竭,26例併髮ARDS,38例需行機械通氣;27例繼髮感染,其中肺部感染24例(呼吸機相關肺炎10例).髮病早期C反應蛋白升高,平均為(131±130)mg/L,CD4+及CD8+T細胞計數降低,分彆為(217±139)/μl和(162±82)/μl;隨病程進展,死亡病例的C反應蛋白持續升高,T細胞亞群計數持續降低,繼髮真菌感染的比例明顯高于存活組(P<0.05);Logistic迴歸分析結果顯示,體重指數高及繼髮真菌感染的患者病死率明顯增高(OR值分彆為6.512和19.631,P均<0.05);髮病48 h內使用奧司他韋抗病毒治療者中未齣現死亡病例. 結論 青壯年、肥胖、伴基礎疾病和妊娠的甲型流感患者易進展為危重癥;C反應蛋白水平持續升高及T細胞亞群計數持續降低提示預後不良;體重指數高及繼髮真菌感染者病死率高;早期應用奧司他韋治療可降低病死率.
목적 료해신형갑형H1N1류감(간칭갑형류감)위중병례적림상특점,탐토여사망상관적위험인소. 방법 채용전첨성연구방법분석북경지단의원2009년10월3일지12월15일수치적55례갑형류감위중병례적림상특점,병대존활병례화사망병례진행비교분석. 결과 55례중남31례,녀24례,년령10개월지84세,평균(38±20)세.위중환자중<65세48례(48/55),비반33례(33/49),반기출질병26례(26/49),임신6례(6/24),림상표현위고열、해수、해담(부분위혈담)급호흡곤난,쌍폐가문급간습성라음.55례중54례병발호흡쇠갈,26례병발ARDS,38례수행궤계통기;27례계발감염,기중폐부감염24례(호흡궤상관폐염10례).발병조기C반응단백승고,평균위(131±130)mg/L,CD4+급CD8+T세포계수강저,분별위(217±139)/μl화(162±82)/μl;수병정진전,사망병례적C반응단백지속승고,T세포아군계수지속강저,계발진균감염적비례명현고우존활조(P<0.05);Logistic회귀분석결과현시,체중지수고급계발진균감염적환자병사솔명현증고(OR치분별위6.512화19.631,P균<0.05);발병48 h내사용오사타위항병독치료자중미출현사망병례. 결론 청장년、비반、반기출질병화임신적갑형류감환자역진전위위중증;C반응단백수평지속승고급T세포아군계수지속강저제시예후불량;체중지수고급계발진균감염자병사솔고;조기응용오사타위치료가강저병사솔.
Objective To understand the clinical features of critically ill patients with pandemic 2009 influenza A(H1N1)and investigate the risk factors associated with death cases. Methods The clinical features of 55 critically ill patients with pandemic 2009 influenza A(H1N1)viral infection hospitalized at Beijing Ditan Hospital from October 3 to December 15,2009 were retrospectively analyzed,and a comparative analysis was performed on the manifestations of the survival and the death groups of patients. Results There were 31 males and 24 females.The age ranged from 10 months to 84 year old,and the mean(SD)was 38(20)year old.The critically ill cases were more in patients under age 65(48/55),with obesity(33/49),with underlying diseases(26/49),and pregnancy(6/24).Both the survivors and non-survivors of patients had high fever,cough,sputum(some sputum with blood),dyspnea,r(a)les of both lungs fields.and all further developed severe pneumonia.The patients also showed respiratory failure(54/55)and ARDS(26/55).All of them received oseltamivir therapy,and 38 patients received mechanical ventilation and 30 were giyen steroid therapy.Secondary infection occurred in 27 cases.and ventilatorassociated pneumonia happened in 10 patients.In the early stage of onset,C-reactive protein(CRP) increased [ (131 ± 130)mg/L] and low counts of T lymphecytes were present [ CD4+ , CD8+T was (217 ±139)/μl and (162 ± 82)/μl]. With the progress of disease, the non-survival cases had persistently increased CRP and the counts of T lymphocytes did not recover, while the secondary fungal infection was significantly higher than in the survivor cases (P <0. 05). By using BMI, underlying diseases, ARDS, the day of Oseltamivir initiated, steroid therapy, following bacterial and fungal infection as variables through logistic regression analysis, it was shown that higher BMI and following fungal infection were associated with higher fatal risks ( OR was 6. 512, 19. 631 respective0ly, both of P value was low than 0. 05 ). There was no death case who received oseltamivir treatment within 48 hours of onset of disease. Conclusions Critical illness in pandemic 2009 influenza A (H1N1)was associated with patients under age 65, with obesity,underlying diseases, and pregnancy. Persistently increased CRP and lower counts of T lymphocytes were associated with unfavorable prognosis. The patients with higher BMI and secondary fungal infection had higher fatal risks. Oseltamivir treatments at early stage would probably reduce mortality.
