重症呼吸道合胞病毒肺炎的危险因素分析  

Risk factors of severe respiratory syncytial virus pneumonia

作　　者：龚成[1] 王雪 罗明[1] 刘阳[2] 李爱华[1] 李茂中[1] 董梅[1] Gong Cheng;Wang Xue;Luo Ming;Liu Yang;Li Aihua;Li Maozhong;Dong Mei(Institute of Immunization and Prevention,Beijing Center for Disease Control and Prevention,Beijing Research Center for Preventive Medicine,Beijing 100013,China;Capital Medical University,Beijing 100013,China)

机构地区：[1]北京市疾病预防控制中心,北京市预防医学研究中心,北京100013 [2]首都医科大学,北京100013

出　　处：《疾病监测》2020年第7期613-617,共5页Disease Surveillance

基　　金：国家科技重大专项(No.2017ZX10103004)。

摘　　要：目的探索呼吸道合胞病毒肺炎发展为重症的独立危险因素。方法利用北京市呼吸道病原体监测系统,收集北京市35家哨点医院就诊的肺炎患者的临床资料,采集临床标本,开展呼吸道合胞病毒的检测和基因分型,并根据收集的临床数据,进行单因素和多因素logistic回归分析,寻找重症呼吸道合胞病毒肺炎的危险因素。结果 2015年3月至2019年2月,共收集369例呼吸道合胞病毒肺炎病例,其中重症肺炎61例。单因素分析表明,重症呼吸道合胞病毒肺炎患者与普通呼吸道合胞病毒肺炎患者相比,年龄、性别、基础疾病、意识障碍、呼吸频率异常增快、收缩压低于90 mmHg、淋巴细胞减少、血尿素氮增高8项指标的差异有统计学意义。多因素logistic回归分析表明,合并基础疾病(OR=4.108,95%CI:1.425~11.840)、呼吸频率异常增快(OR=10.738,95%CI:3.690~31.252)、淋巴细胞减少(OR=6.110,95%CI:2.041~18.288)是重症呼吸道合胞病毒肺炎的3个独立危险因素;而女性(OR=0.471,95%CI:0.199~1.115)、呼吸道合胞病毒B亚型(OR=0.425,95%CI:0.158~1.141)可能为重症肺炎的保护因素(差异无统计学意义)。结论有基础疾病、呼吸频率异常增快、淋巴细胞减少是呼吸道合胞病毒肺炎发展为重症的独立危险因素,临床诊治过程中应予以重视。Objective To understand the risk factors of severe respiratory syncytial virus(RSV) pneumonia. Methods By using Respiratory Pathogen Surveillance System in Beijing, pneumonia cases were recruited from 35 sentinel hospitals in Beijing. Their demographic and medical data were collected and their clinical specimens were obtained. Laboratory detection and genotype identification of RSV were performed. Univariate and multivariate analyses were applied to identify the risk factors for severe RSV pneumonia. Results From March 2015 to February 2019, a total of 369 RSV pneumonia cases were surveyed, including 61 severe pneumonia cases. Univariate analysis showed that the differences in age distribution, gender distribution, prevalence of underlying disease, prevalence of disorder of consciousness, abnormally elevated respiratory rate,systolic blood pressure<90 mmHg, prevalence of lymphocytopenia and abnormally elevated blood urea nitrogen level between severe RSV pneumonia cases and mild RSV pneumonia cases were significant. Multivariate analysis showed that underlying disease(OR=4.108, 95% CI: 1.425–11.840), abnormally elevated respiratory rate(OR=10.738, 95% CI: 3.690–31.252), lymphocytopenia(OR= 6.110, 95% CI: 2.041–18.288) were the independent risk factors for severe RSV pneumonia.However, being female(OR=0.471, 95% CI: 0.199–1.115), RSV subtype B(OR=0.425, 95% CI: 0.158–1.141) might be the protective factors for severe RSV pneumonia, even though no significant difference was observed. Conclusion Underlying disease, abnormally elevated respiratory rate and lymphocytopenia were the independent risk factors for the development of severe RSV pneumonia, to which close attention should be paid in clinical diagnosis and treatment.

关 键 词：呼吸道合胞病毒 重症肺炎 危险因素 多因素分析 淋巴细胞减少症 

分 类 号：R211[医药卫生—中医学] R446.5