呼吸重症监护病房免疫功能正常患者巨细胞病毒激活的特点及危险因素  

Analysis of clinical characteristics and risk factors of cytomegalovirus reactivation in immunocompetent patients in respiratory intensive care unit

作　　者：王玺[1] 刘亚男 金哲[1] 黄珺君[1] 黄俊芳[1] 廖纪萍[1] 马靖[1] 王广发[1] Wang Xi;Liu Yanan;Jin Zhe;Huang Junjun;Huang Junfang;Liao Jiping;Ma Jing;Wang Guangfa(Department of Respiratory and Critical Care Medicine,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院呼吸和危重症医学科,北京100034

出　　处：《中华医学杂志》2019年第40期3168-3171,共4页National Medical Journal of China

摘　　要：目的分析呼吸重症监护病房(RICU)免疫功能正常患者巨细胞病毒(CMV)激活的特点及危险因素。方法回顾性分析81例于2014年7月至2018年7月在北京大学第一医院RICU住院期间定期监测血清CMV-DNA的免疫功能正常患者的临床资料。根据住院期间是否出现CMV激活分为激活组和未激活组。分析两组患者的人口学资料、临床特征、治疗和转归等,并使用多因素Logistic回归分析CMV激活的独立危险因素。结果81例患者中,激活组11例(13.6%)、未激活组70例(86.4%)。激活组RICU住院时间显著长于未激活组[54(50,68)比32(17,43)d,P=0.012],而入院时基线资料、呼吸机相关性肺炎发生率、机械通气时间和院内病死率与未激活组差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示红细胞输注(OR=11.481,95%CI:1.154~114.201;P=0.037)和使用糖皮质激素(OR=13.952,95%CI:2.301~84.609;P=0.004)是RICU免疫功能正常患者住院期间CMV激活的独立危险因素。结论免疫功能正常的呼吸重症患者住院期间CMV激活者RICU住院时间长,红细胞输注和使用糖皮质激素是此类患者CMV激活的独立危险因素。Objective To investigate the clinical characteristics and risk factors of cytomegalovirus(CMV)reactivation in immunocompetent patients in respiratory intensive care unit(RICU).Methods Clinical data of immunocompetent patients whose serum CMV-DNA was monitored during hospitalization in the RICU of Peking University First Hospital from July 2014 to July 2018 were collected and reviewed in this retrospective study.Patients were divided into the CMV reactivation group and non reactivation group.Demographics,clinical features,and outcomes of patients in the two groups were analyzed.The multivariable logistic regression analysis was used to analyze the independent risk factors for CMV reactivation.Results Of the 81 patients,11(13.6%)were in the reactivation group and 70(86.4%)were in the non reactivation group.Length of RICU stay were longer in the group with CMV reactivation compared to patients without CMV reactivation[54(50,68)vs 32(17,43)d,P=0.012].Baseline demographic and disease characteristics,rate of ventilator-associated pneumonia,duration of mechanical ventilation and mortality were similar in the two groups.Multivariable logistic regression analysis showed that blood transfusion(OR=11.481,95%CI:1.154-114.201;P=0.037)and corticosteroids use(OR=13.952,95%CI:2.301-84.609;P=0.004)were independent risk factors for CMV reactivation.Conclusions CMV reactivation is associated with a longer stay in the RICU in immunocompetent patients,blood transfusion and corticosteroids use constitute risk factors.

关 键 词：巨细胞病毒 免疫 重症监护病房 疾病特征 危险因素 

分 类 号：R47[医药卫生—护理学]