甲型H1N1流感患者并发肺炎的危险因素研究  

Risk Factors for Pneumonia Complicated in Patients with Influenza A(H1N1)

作　　者：赵志伟[1] 张庆[1] 邢志俐[2] 张勃[1] 郑洪飞[1] 孙立新[3] 何权瀛[4] 

机构地区：[1]承德医学院附属医院呼吸科,河北省承德市067000 [2]天津泰达医院ICU [3]承德医学院附属医院中心实验室 [4]北京大学人民医院呼吸科

出　　处：《中国全科医学》2013年第7期770-772,共3页Chinese General Practice

基　　金：承德市科学技术研究与发展计划项目(20122175)

摘　　要：目的探讨甲型H1N1流感患者并发肺炎的危险因素。方法将承德地区2009年9—12月全部确诊为新型甲型H1N1流感患者集中免费收治于传染病医院,共206例,确诊依据符合卫生部办公厅印发的《甲型H1N1流感诊疗方案(2009年第三版)》,所有患者咽拭rt-PCR病毒核酸检测阳性。承德市卫生局统一抽调医护人员给予诊治,诊治过程严格按照诊疗方案进行并记录。按就诊最终的影像学表现将患者分为肺炎组和非肺炎组,对两组患者的临床特征进行病例对照研究,并进行统计分析。结果单因素分析显示:肺炎组中0～5岁、≥45岁、有基础疾病、首发症状有咳嗽、咳痰、呼吸困难、发病到就诊>48 h、职业为学龄前、农民、无业及离退休和其他职业的患者比例高于非肺炎组,差异均有统计学意义(P<0.05),以上因素为易患肺炎的可能危险因素;对可能危险因素行多因素Logistic回归分析显示:0～5岁〔OR=6.120,95%CI(1.776,21.088)〕、有基础疾病〔OR=11.188,95%CI(2.021,61.935)〕、首发症状有咳痰〔OR=5.263,95%CI(2.042,13.562)〕、发病到就诊>48 h〔OR=22.873,95%CI(6.110,85.631)〕是甲型H1N1流感肺炎的独立危险因素(P<0.01)。结论 0～5岁、有基础疾病、首发症状有咳痰、发病到就诊>48 h的甲型H1N1流感患者易患肺炎,在未来甲型流感大流行期间对具有以上危险因素的患者应给予重视。Objective To investigate the risk factors for pneumonia complication in patients with influenza A （H1N1） . Methods Totally 206 patients, diagnosed with novel influenza A （HIN1） in Chengde area during September and December of 2009 according to ＂ Protocol for Diagnosis and Treatment of Influenza A （ H1 N1 ） （2009 Third Edition） ＂ issued by the General Office of Ministry of Health, were admitted in Chengde Hospital for Infectious Diseases for free treatment. The definite diagnosis was made by positive viral nucleic acid test of the throat swabs using real - time RT - PCR, and the procedure of diagnosis and treatment was strictly conducted according to the programmed protocol and recorded. Based on the final imaging findings the patients were divided as pneumonia group and non - pneumonia group. The case control study was carried out on the clinical characteristics of the patients in the 2 groups, with statistical analysis. Results Univariate analysis showed that the ratios of patients aged 0 -5 years and ≥45 years, with underlying diseases, with initial symptoms of cough, expectoration and dyspnea, whose onset- to- treatment interval 〉 48 hours, who were preschool children, farmer, unemployed or retired were higher in pneumonia group than in non - pneumonia group, with statistically significant difference （ P 〈 0. 05 ） . The above - mentioned factors might be potential risk factors for susceptibility to pneumonia. Multivariate logistic regression analysis showed that 0 -5 years of age [ OR = 6. 120, 95% CI （ 1. 776, 21. 088） ], presence of underlying diseases [ OR = 11. 188, 95% CI （2. 021, 61. 935 ） 3, expectoration as initial symptom [ OR = 5. 263, 95% CI （2. 042, 13. 562） ], onset - to - treatment interval 〉 48 hours （OR =22. 873, 95%CI （6. 110, 85. 631） ] were the independent risk factors for influenza A （H1N1） pneumonia （P〈 0. 01 ） . Conclusion Influenza A （ H1 N1 ） patients aged 0 -5 years, with underlying diseases, expectoration as initial sympt

关 键 词：流行性感冒 人 流感病毒A型 H1N1亚型 肺炎 危险因素 

分 类 号：R373.13[医药卫生—病原生物学]