福建省人感染H7N9禽流感诊疗特征分析  

Diagnosis and treatment of human infection with avian influenza A(H7N9) Virus in Fujian Province, China

作　　者：陈光敏[1] 谢剑锋[1] 林兰[2] 欧剑鸣[1] 郑月燕 郑奎城[1] CHEN Guang-min;XIE Jian-feng;LIN Lan;OU Jian-ming;ZHENG Yue-yan;ZHENG Kui-cheng(Fujian Provincial Center for Disease Control and Prevention,Fujian Provincial Key Laboratory of Zoonosis Research,Fuzhou 350001,China;Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省疾病预防控制中心、福建省人兽共患病研究重点实验室,福州350001 [2]福建省立医院,福州350001

出　　处：《中国人兽共患病学报》2019年第11期1051-1056,共6页Chinese Journal of Zoonoses

基　　金：国家科技重大专项课题(No.2017ZX10103008);福建省2016年卫生计生青年科研课题(No.2016-1-18)联合资助~~

摘　　要：目的分析福建省人感染H7N9禽流感诊疗特征,以期为疾病防控和临床救治提供参考。方法采用SPSS 23.0、SAS9.2软件对福建省人感染H7N9禽流感诊疗特征进行描述性分析。结果福建省共报告108例病例,死亡28人,病死率25.93%。病例从发病到就诊、住院、确诊和抗病毒治疗中位数分别为3 d、5 d、7 d和6 d,死亡病例组发病至死亡中位数16 d,从发病至实验室确诊比早期提前1 d。一半以上病例没有在5 d内使用抗病毒治疗药物,死亡风险可能没有得到有效降低。46.3%的病例伴有基础疾病,随年龄增长患基础疾病和重症率增加(Z=4.75,P<0.01;Z=5.07,P<0.01)。男女病死率比较,差异无统计学意义(χ^2=28.37,P<0.01),各年龄组病死率比较,差异无统计学意义(χ^2=2.23,P=0.53)。患心血管疾病(OR=2.60,95%CI:1.06~6.39)、出现肺炎(OR=1.27,95%CI:1.13~1.42)、重症(OR=1.24,95%CI:1.13~1.42)、需进ICU(OR=3.80,95%CI:1.20~11.99)、合并细菌感染需要使用抗生素(OR=1.19,95%CI:1.08~1.32)和需使用激素(OR=7.47,95%CI:1.64~33.95)等因素增加病死风险。结论福建省人感染H7N9禽流感病例诊断能力较早期有所提高,抗病毒治疗仍不及时。当患者伴有心血管疾病和需要使用激素等危险因素时,应积极加强救治,降低病死率。To analyze the diagnosis and treatment characteristics in human infected with avian influenza A(H7N9)Virus in Fujian Province,and to provide evidence for control strategies and treatment,descriptive statistics was used to describe the diagnosis and treatment characteristics of the cases by SPSS23.0 and SAS9.2.The results showed that there were 108 cases and 28 deaths in Fujian Province,the fatality rate was 25.93%.The median durations from onset to treatment,hospitalization,diagnosis and antiviral therapy were 3 days,5 days,7 days,and 6 days,respectively.The median duration from disease onset to death was 16 days.The median durations from onset to diagnosis was 1 day earlier than the early stage.More than half of the cases were not treated with antiviral therapy within 5 days,and the risks of death may not been reduced.The 46.3%of the cases also had chronic diseases.The increase of age was associated with elevated chronic disease prevalence and the incidence of critically ill cases(Z=4.75,P<0.01;Z=5.07,P<0.01).No significant differences were found in case fatality rates between male and female,nor among the age groups.However,case fatality was related to cardiovascular disease(OR=2.60,95%CI:1.06-6.39),pneumonia(OR=1.27,95%CI:1.13-1.42),critically ill(OR=1.24,95%CI:1.13-1.42),requiring ICU(OR=3.80,95%CI:1.20-11.99),multiple bacteria infections with antibiotic treatment(OR=1.19,95%CI:1.08-1.32)and requiring hormonal treatment(OR=7.47,95%CI:1.64-33.95).In conclusions,the diagnostic ability has been improved,but the treatment with antiviral therapy is still not timely.Clinicians should actively strengthen the treatment to reduce the fatalities when patients with avian Influenza A(H7N9)Virus associated with cardiovascular diseases,and requiring hormonal treatment and other risks for death.

关 键 词：人感染H7N9禽流感 诊疗特征 死亡 

分 类 号：R183.3[医药卫生—流行病学]