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
2008年
7期
483-487
,共5页
曹彬%LI Ran%刘颖梅%CAO Zhi-xin%耿秀琴%LAU Lok-ting%卢洁%WU Lin%崔树峰%BAI Rui-ting%于常海%WANG Chen
曹彬%LI Ran%劉穎梅%CAO Zhi-xin%耿秀琴%LAU Lok-ting%盧潔%WU Lin%崔樹峰%BAI Rui-ting%于常海%WANG Chen
조빈%LI Ran%류영매%CAO Zhi-xin%경수금%LAU Lok-ting%로길%WU Lin%최수봉%BAI Rui-ting%우상해%WANG Chen
正黏病毒科%抗菌药%费用,医疗%流感样疾病
正黏病毒科%抗菌藥%費用,醫療%流感樣疾病
정점병독과%항균약%비용,의료%류감양질병
Orthomyxoviridae%Anti-bacterial agents%Fees,medical%Influenza-like illness
目的 了解北京地区"流感样疾病"的病原谱与抗菌药物治疗及预后的关系.方法 采用前瞻性队列研究方法 ,选取符合卫生部流感样疾病定义的发热门诊患者,留取咽分泌物进行细菌学和病毒学榆测,调查患者的年龄、基础疾病、呼吸道症状、肺外表现和实验室检查,分析治疗和预后的关系.采用SPSS 10.0统计软件进行汇总分析.计量资料采用t榆验或秩和检验,计数资料采用χ2检验,退热时间的影响因素采用Cox回归分析.结果 2006年12月至2007年4月共入选"流感样疾病"患者476例,最终资料完整的454例纳入分析.除副流感嗜血杆菌外,流感病毒是最主要的致病原(197例,43.4%),其他病原体少见.454例患者的平均年龄为(33 ±13)岁,男:女为1.1:1,1年内有流感疫苗接种史的24例(5.3%),接受抗菌约物治疗的288例(63.4%),无接受奥司他韦或金刚烷胺等抗流感病毒药物的患者.与流感病毒阴性组相比,流感病毒阳性组年龄较大、基础疾病较多,咳嗽、咽痛和全身症状的比例较高,但无统计学意义.流感病毒阳性组表现为流感综合征(体温≥39℃,同时伴有咳嗽、咽痛、头痛或全身肌肉酸痛)的比例显著高于流感病毒阴性组.流感病毒阳性组197例中用抗菌药物治疗的132例(67.0%),抗菌药物治疗组外周血白细胞总数、中性粒细胞比例、血小板计数高于未用抗菌药物组;应用抗菌药物组的医疗费用比不用抗菌药物组约高1倍,但平均退热时间、症状缓解时间及复诊率无统计学意义.Cox回归分析结果 显示,白细胞和中性粒细胞百分比增高是退热时间延长的独立危险因素(OR值分别为1.049和1.014),但抗生素使用不影响退热时间.结论 在冬春季节北京地区"流感样疾病"的主要病原体是流感病毒;对于单纯"流感样疾病",抗菌药物治疗不缩短病程,但费用却大大增加.因此,研究并制定流感样疾病诊断和治疗规范非常必要.
目的 瞭解北京地區"流感樣疾病"的病原譜與抗菌藥物治療及預後的關繫.方法 採用前瞻性隊列研究方法 ,選取符閤衛生部流感樣疾病定義的髮熱門診患者,留取嚥分泌物進行細菌學和病毒學榆測,調查患者的年齡、基礎疾病、呼吸道癥狀、肺外錶現和實驗室檢查,分析治療和預後的關繫.採用SPSS 10.0統計軟件進行彙總分析.計量資料採用t榆驗或秩和檢驗,計數資料採用χ2檢驗,退熱時間的影響因素採用Cox迴歸分析.結果 2006年12月至2007年4月共入選"流感樣疾病"患者476例,最終資料完整的454例納入分析.除副流感嗜血桿菌外,流感病毒是最主要的緻病原(197例,43.4%),其他病原體少見.454例患者的平均年齡為(33 ±13)歲,男:女為1.1:1,1年內有流感疫苗接種史的24例(5.3%),接受抗菌約物治療的288例(63.4%),無接受奧司他韋或金剛烷胺等抗流感病毒藥物的患者.與流感病毒陰性組相比,流感病毒暘性組年齡較大、基礎疾病較多,咳嗽、嚥痛和全身癥狀的比例較高,但無統計學意義.流感病毒暘性組錶現為流感綜閤徵(體溫≥39℃,同時伴有咳嗽、嚥痛、頭痛或全身肌肉痠痛)的比例顯著高于流感病毒陰性組.流感病毒暘性組197例中用抗菌藥物治療的132例(67.0%),抗菌藥物治療組外週血白細胞總數、中性粒細胞比例、血小闆計數高于未用抗菌藥物組;應用抗菌藥物組的醫療費用比不用抗菌藥物組約高1倍,但平均退熱時間、癥狀緩解時間及複診率無統計學意義.Cox迴歸分析結果 顯示,白細胞和中性粒細胞百分比增高是退熱時間延長的獨立危險因素(OR值分彆為1.049和1.014),但抗生素使用不影響退熱時間.結論 在鼕春季節北京地區"流感樣疾病"的主要病原體是流感病毒;對于單純"流感樣疾病",抗菌藥物治療不縮短病程,但費用卻大大增加.因此,研究併製定流感樣疾病診斷和治療規範非常必要.
목적 료해북경지구"류감양질병"적병원보여항균약물치료급예후적관계.방법 채용전첨성대렬연구방법 ,선취부합위생부류감양질병정의적발열문진환자,류취인분비물진행세균학화병독학유측,조사환자적년령、기출질병、호흡도증상、폐외표현화실험실검사,분석치료화예후적관계.채용SPSS 10.0통계연건진행회총분석.계량자료채용t유험혹질화검험,계수자료채용χ2검험,퇴열시간적영향인소채용Cox회귀분석.결과 2006년12월지2007년4월공입선"류감양질병"환자476례,최종자료완정적454례납입분석.제부류감기혈간균외,류감병독시최주요적치병원(197례,43.4%),기타병원체소견.454례환자적평균년령위(33 ±13)세,남:녀위1.1:1,1년내유류감역묘접충사적24례(5.3%),접수항균약물치료적288례(63.4%),무접수오사타위혹금강완알등항류감병독약물적환자.여류감병독음성조상비,류감병독양성조년령교대、기출질병교다,해수、인통화전신증상적비례교고,단무통계학의의.류감병독양성조표현위류감종합정(체온≥39℃,동시반유해수、인통、두통혹전신기육산통)적비례현저고우류감병독음성조.류감병독양성조197례중용항균약물치료적132례(67.0%),항균약물치료조외주혈백세포총수、중성립세포비례、혈소판계수고우미용항균약물조;응용항균약물조적의료비용비불용항균약물조약고1배,단평균퇴열시간、증상완해시간급복진솔무통계학의의.Cox회귀분석결과 현시,백세포화중성립세포백분비증고시퇴열시간연장적독립위험인소(OR치분별위1.049화1.014),단항생소사용불영향퇴열시간.결론 재동춘계절북경지구"류감양질병"적주요병원체시류감병독;대우단순"류감양질병",항균약물치료불축단병정,단비용각대대증가.인차,연구병제정류감양질병진단화치료규범비상필요.
Objective To study the etiology of influenza-like illness (ILI) in Beijing,and to investigate the impact of antibiotic treatment on outcomes.Methods This was a prospective cohort study.Patients with diagnosis of influenza-like illness were prospectively enrolled for study of bacterial and viral pathogens.Demographic characteristics,underlying diseases, respiratory and extrapulmonary symptoms,laboratory tests were also collected for analysis of relationship between drug therapy and outcomes. Results A total of 476 cases were enrolled between Dec.2006 and Apr.2007,of whom 454 cases were used for analysis. Influenza virus was the most common pathogen ( n = 197,43.4% ),with uther pathogens rarely seen.The mean age of the patients was (33 ± 13 ) years,and the ratio of male to female was 1.1: 1.Twenty four patients (5.3%) received influenza vaccine.The rate of antibiotic prescription after onset of illness was 63.4%, but none received antiviral drugs such as Osehamivir and amantadine. Compared with influenza-negative patients, patients with influenza were older, had more underlying diseases and had greater severity of symptoms such as cough, sore throat, headache and myalgia ( but with no statistical differences).The-influenza syndrome (T≥39 ℃ plus cough, sore throat and headache or myalgia) was more common in the influenza group compared to the influenza-negative patients (P< 0. 05). The ratio of antibiotic prescription was 67% in the influenza group, and the total white blood cell and platelet count,percentage of neutrophils were higher in antibiotic treatment patients compared with non-antibiotic treatment patients (P <0. 01 ). The cost in patients who received antibiotics was twice as much as non-antibiotic treatment patients ( P <0. 05),but the defervescence time and respiratory symptom alleviation time did not differ.Cox regression analysis showed that the total white blood count and the differentials (OR value 1. 049 and 1. 014 ,respectively), but not antibiotic use were the independent risk factors for longer defervescence time. Conclusion Influenza virus was the most common pathogen for adult patients with ILI in Beijing city during the winter and the spring seasons. Antibiotic treatment of adult patients with ILI did not improve illness resolution, while the cost was increased significantly.
