流行性感冒老年患者的临床特点及预后影响因素  

Clinical characteristics and prognostic factors of influenza in the elderly

作　　者：李侗曾[1] 蔡妙甜[1] 张美[1] 段忠辉[1] 牟丹蕾[1] 梁连春[1] LI Tongzeng;CAI Miaotian;ZHANG Mei;DUAN Zhonghui;MOU Danlei;LIANG Lianchun(Department of General Infection,Beijing You'an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院感染综合科,北京100069

出　　处：《中国感染与化疗杂志》2020年第4期362-367,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的研究流行性感冒(流感)流行季节流感老年患者的临床特征,为流感老年患者预防治疗提供依据。方法收集2019年1-3月确诊流感的成人患者临床资料,包括一般情况、基础疾病、临床症状、实验室检查结果等,同时留取患者的鼻咽拭子进行流感病毒核酸检测。结果共收集流感老年(年龄≥65岁)患者64例,非老年患者39例,均未接种流感疫苗。老年患者中单纯甲型流感55例(85.9%),体温≥38.5 ℃的患者占65.6%;其他症状主要表现为咳嗽(95.2%)、咯痰(87.5%)、乏力(84.4%)、胸闷(46.9%)、流涕(45.3%);合并心肌损伤46例(71.9%),合并细菌性肺炎40例(62.5%);实验室检查显示C反应蛋白[中位数38.5(23.4,89.1)mg/L]、降钙素原[中位数0.09(0.05,0.68)μg/L]轻度升高;病毒核酸检测转阴中位时间为6.0(5.0,8.0)d,共6例患者死亡,占9.4%。非老年患者的临床症状及合并症、实验室检查结果均较老年患者表现轻。老年患者中死亡组合并细菌性肺炎、既往器官功能障碍、多脏器功能衰竭、脓毒症、酸碱失衡的概率高于生存组,差异有统计学意义(P<0.05)。结论目前流感疫苗接种率低,流感老年患者病情较重,易合并心肌损伤、细菌性肺炎等并发症,临床医师应关注流感老年患者脏器功能,进行综合多方位的防护,避免死亡的发生。Objective To study the clinical characteristics of senile influenza patients in influenza epidemic season and provide evidence for the better prevention and treatment.Methods Clinical data of patients who were diagnosed with influenza from January to March 2019 were collected,including general information,underlying diseases,clinical symptoms,laboratory results.Nasopharyngeal swabs were collected for detection of influenza nucleic acid.Results A total of 64 old patients (65 years or older) with influenza and 39 non-old patients were collected.All patients did not receive influenza vaccine.Overall,55 (85.9%) old patients had influenza A alone.Fever (≥38.5 ℃) was recorded in 65.6% of the old patients.Other symptoms were cough (95.2%),sputum (87.5%),fatigue (84.4%),chest tightness (46.9%),and runny nose (45.3%).Additionally,46 (71.9%) patients were complicated with myocardial injury and 40 (62.5%) complicated with bacterial pneumonia.Laboratory tests showed that the medians (interquartile range) of C-reactive protein 38.5(23.4,89.1) mg/L and procalcitonin 0.09 (0.05,0.68) μg/L were slightly elevated.The median time to negative nucleic acid conversion was 6.0 (5.0,8.0) days.A total of 6 (9.4%) patients died.Old patients had more severe clinical symptoms,complications,and laboratory test results than non-old patients.The old patients with fatal outcome had significantly higher risk of bacterial pneumonia,prior organ dysfunction,multiple organ failure,sepsis,and acid-base imbalance (P<0.05).Conclusions The influenza vaccination coverage is still low at present time.Elderly influenza patients are in serious condition and prone to complications such as myocardial injury and bacterial pneumonia.Clinicians should pay attention to the organ functions of elderly patients in case of influenza and take comprehensive preventive measures to avoid death.

关 键 词：老年 流感 临床特点 预后 影响因素 

分 类 号：R373.13[医药卫生—病原生物学]