289例新型甲型H1N1流感患者存活与死亡病例的临床分析  

Clinical analysis of survival and death cases in 289 patients with novel influenza A（H1N1 ）

作　　者：谭伟[1] 代冰[1] 孙龙凤[1] 孔德磊[1] 赵洪文[1] 康健[1] 

机构地区：[1]中国医科大学附属第一医院呼吸内科,沈阳110001

出　　处：《国际呼吸杂志》2011年第6期411-414,共4页International Journal of Respiration

基　　金：辽宁省医学高峰建设工程重点科研项目（200922）

摘　　要：目的分析新型甲型H1N1流感患者死亡的危险州素。方法对辽宁省289例新型甲型H1N1流感患者（死亡29例）病程早期的临床资料进行回顺性分析，比较死亡组和存活组之间临床特征，采用多变量Logistic同归分析确定患者死亡的危险因素。结果单因素分析中，与存活组相比，死亡组体质量指数较高（P〈0．05），妊娠如女、伴有基础疾病比例较高（P值均〈0．01），T细胞亚群较低（P〈0．01），奥司他韦初始治疗时间较长（P〈0．01），APACHEIf评分和△SOFA评分较高（P值均〈0．01），继发细菌感染和继发真菌感染患者比例较高（P值均〈0．01）。多变量Logistic回归分析硅乐体质量指数（OR=5．05，95％CI：1．368～30．8，P=0．035）、继发真菌感染（OR=9．34，95％CI：1．564～48．9，P=0．027）、APACHE11评分〉20分（OR=1．245，95％ CI：1．078～1．754，P=0．029）和△SOFA评分（OR—1．346，95％CI：1．052～1．965，P=0．011）是甲型H1N1流感患者死亡的独立危险因素。结论临床上应重视并针对上述危险因素制订相应的防治措施，以期降低病死率。Objective To explore the risk factors of death in patients with novel influenza A（H1N1）.Methods The clinical data of 289 patients with novel influenza A（H1N1） （29 cases of death） were retrospectively analyzed. The clinical characteristics between death group and survival group were compared. The risk factors of death in patients were identified by multivariate hogistic regression analysis. Results Compared with survival group, the body mass index was higher （ P 〈 0.05）, the proportion of pregnanl women or underlying disease was higher （all P 〈0.01）, T cell subsets were lower （ P 〈0.01）, the initial treatment time of oseltamivir was longer （ P 〈0.01）, APACHE 11 score and ~S（）FA score were higher （all P 〈 0.01 〉, the proportion of secondary bacterial infeclion or fungal infection patients was higher （all P G0.01） in death group. Multivariate Logistic regression analysis showed that body mass index （ OR = 5.05,95% CI ：1. 368-,30.8, P 0. 035）, secondary fungal infection （OR 9.34,95 CI ：1.564 48.9, P 0.027）, APACHE II score〉20 （OR=1.245,95% CI ： 1. 078 1.754. P=0.029）, and △ SOFA score （ OR=1.346,95% CI ：1.052 1.965, P=0.011） were independent risk factors of death in patients with novel influenza A（ H1N1）. Conclusions The risk factors of death above should be taken more attention and appropriate control measures should be made to reduce mortality.

关 键 词：新型甲型H1N1流感 死亡危险因素 继发感染 

分 类 号：R511.7[医药卫生—内科学]