2013-2015年浙江地区哨点医院H3N2甲型流感病毒感染患者临床特点与流行病学特征  

Clinical features and epidemiological characteristics of influenza A (H3N2) virus infection in sentinel hospitals in Zhejiang province from 2013 to 2015

作　　者：孙海燕[1,2,3] 崔大伟[1,2] 车飞虎[1,2] 高敏[1,2] 杨先知[1,2] 谢国良[1,2] 陈瑜[1,2] 

机构地区：[1]浙江大学医学院附属第一医院检验科,浙江杭州310003 [2]浙江省临床体外诊断技术研究重点实验室,浙江杭州310003 [3]绍兴第二医院检验科,浙江绍兴312000

出　　处：《中国微生态学杂志》2016年第12期1374-1378,共5页Chinese Journal of Microecology

基　　金：国家科技重大专项(2012ZX10004-210);浙江省医药卫生科技项目(2015KYB149)

摘　　要：目的分析2013-2015年浙江地区哨点医院监测纳入的H3N2甲型流感病毒感染患者的临床特点及流行病学特征。方法对2013年1月至2015年12月浙江地区8家哨点医院纳入的符合急性呼吸道感染（acute respiratory infection,ARI）定义的病例进行流行病学和临床信息调查,采集呼吸道标本进行流感病毒核酸检测。按检测结果将病例分为H3N2阳性组和流感阴性组,分析两组病例流行病学和临床特征。结果 2013-2015年浙江地区8家哨点医院共纳入7 602例急性呼吸道感染,其中实验室确诊H3N2病例490例（占6.4%）。浙江地区连续3年的监测共出现3次发病高峰,分别是2013年12月-2014年3月、2015年1-3月和2015年7-8月。H3N2病例年龄中位数为50岁,其中男性占62.0%,慢性基础性疾病史、恶性肿瘤病史及吸烟史的患者在H3N2阳性组的比例高于流感阴性组,差异有统计学意义（其中慢性基础性疾病史χ~2=6.600、7.519、3.875、53.719、3.997、31.086、63.789、21.309和53.95;恶性肿瘤史χ~2=55.316;吸烟史χ~2=14.418,P值均〈0.05）。H3N2阳性组出现排痰性咳嗽、咯血、X线/CT表现异常和肺部听诊异常的比例较流感阴性组高,而H3N2阳性组白细胞总数和血小板总数较流感阴性组低,差异均有统计学意义（排痰性咳嗽χ~2=82.703,咯血χ~2=104.807,X线/CT表现异常χ~2=5.114,肺部听诊异常χ~2=11.823;白细胞总数t=-2.602,血小板总数t=-3.488,P值均〈0.05）。结论浙江地区H3N2流感多发生在冬春季和夏季,具有慢性基础性疾病及肿瘤等病情的患者是感染的高危人群。Objective To investigate the clinical features and epidemiological characteristics of human infections with influenza A （H3N2） virus in Zhejiang from 2013 to 2015. Methods Epidemiologie and clinical surveys were conducted on acute respiratory infection （ARI） cases in eight sentinel hospitals in Zhejiang from 2013 to 2015. Respiratory tract specimens were collected for influenza virus detection. The ARI cases were divided into H3N2 positive group or inlluenza negative group, and the clinical and epidemiologie charac teristics were analyzed respectively. Results 7,602 severe ARI cases were included, 490 （6.4 %） cases of which were laboratory confirmed H3N2 infection. Three obvious epidemic peaks were noticed, which occurred during December 2013 to March 2014, January to March 2015 and July to August 2015 respectively. The median age was 50 years, and males accounted for 62.0%. The proportion of patients with history of chronic underlying disease, malignancy and smoking in H3N2 positive group were higher than that in influ enza negative group, with statistically significant difference （P〈 0.05） . Compared to influenza negative group, those who infected with H3N2 virus were more prone to productive cough, hemoptysis, abnormal Xray/CT and abnormal lung auscultation, while their total numbers of white blood cells and platelets were lower, with statistical significance （P〈0. 05） . Conclusion The outbreaks of H3N2 usually occurred in winter and spring or summer in Zhejiang. Patients with chronic underlying disease, cancer or other condi tions were the high risk population.

关 键 词：流感 甲型流感病毒 H3N2亚型 流行病学特征 

分 类 号：R511.7[医药卫生—内科学]