甲型流感社区获得性肺炎患者死亡的危险因素分析  

Risk factors for death of patients with community-acquired pneumonia due to Influenza A

作　　者：陈亮[1] 韩秀迪 邢西迁[3] 朱晓莉 Chen Liang;Han Xiudi;Xing Xiqian;Zhu Xiaoli(Department of Infectious Disease, Beijing Jishuitan Hospital, Beijing 100096 , China)

机构地区：[1]北京积水潭医院感染疾病科,100096 [2]山东省青岛帀立医院呼吸与危重症医学科 [3]昆明医科大学附属延安医院呼吸与危重症医学科 [4]北京朝阳医院中毒与职业病医学科

出　　处：《临床内科杂志》2019年第5期325-328,共4页Journal of Clinical Internal Medicine

摘　　要：目的探讨甲型流感社区获得性肺炎(CAP)患者入院30天死亡的危险因素。方法纳入178例甲型流感CAP患者,依据入院后30天的预后分为存活组144例和死亡组34例。比较两组患者的临床资料、治疗情况及临床结局。采用logistic回归分析评估甲型流感CAP患者入院后30天死亡的独立危险因素。结果死亡组合并冠心病、免疫抑制状态、吸烟史、岀现喘息、意识改变、合并细菌性肺炎、行无创机械通气、有创机械通气、使用血管活性药物、发生呼吸衰竭、急性肾衰竭、脓毒性休克、脑卒中、肝损伤、消化道出血及入住ICU患者比例及肺炎严重指数(PSI)分级、CURB-65评分及血尿素氮均高于存活组,淋巴细胞计数、血白蛋白、血肌酸激酶、动脉血氧合指数均低于存活组(P<0.05)。Logistic回归分析结果显示,血白蛋白升高(OR =0. 816,95% CI 0.754 ~0.969,P =0.010)和外周血淋巴细胞计数升高(OR=0.149,95% CI 0.031-0. 707,P=0.017)是甲型流感CAP患者入院30天死亡的独立保护因素,而血尿素氮升高是其独立危险因素(OR = 1.490,95% CI 1.250-1.776,P<0.001)。结论血白蛋白、外周血淋巴细胞计数和血尿素氮有助于临床医生早期识别高死亡风险的甲型流感CAP患者。Objective To explore the risk factors for 30-day death after admission of patients with community-acquired pneumonia( CAP) due to Influenza A. Methods A total of 178 patients with CAP due to Influenza A were divided into survival group( 144 cases) and death group(34 cases) according to the clinical outcome of 30-day after admission. Clinical features, treatment condition and clinical outcomes were compared between the two groups. logistic regression analysis were performed to evaluate risk factors for 30-day death after admission of patients with CAP due to Influenza A. Results Proportions of patients combined with coronary heart disease, immunosuppressive status, smoking history , wheezing, consciousness change, coinfection with l)acterial pneumonia, noninvasive ventilation, invasive ventilation, vasopressors use,respiratory failiure, acute renal failure, septic shock, stroke, liver injurj , gastrointestinal bleeding,admitted to ICU and pneumonia severity index( PSI) class,CURB-65 score and blood urea nitogen in death group were higher than those in survival group, and peripheral lymphocyte counts, blood albumin, blood creatine kinase and arterial oxygenation index were lower than those in survival group( P <0. 05). Results of logistic regression analysis showed increased blood albumin( OR =0. 816,95% CI 0. 754 -0. 969, P =0. 010) and peripheral blood lymphocyte count ( OR = 0. 149,95% CI 0. 031 - 0. 707 , P = 0. 017 ) were independent protective factors for 30-day death after admission of patients with CAP due to Influenza A , hut increased blood urea were independent risk factor for it ( OR = 1. 490,95% CI 1. 250 ~ 1.776, P < 0. 001 ). Conclusion Blood albumin , peripheral blood lymphocyte counts and blood urea nitrogen are helpful to identify patients with CAP due to Influenza A and high risk of death for clinicians.

关 键 词：甲型流感 社区获得性肺炎 死亡 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]