甲乙型流感早期临床特征以及实验室检测在早期识别中的作用  

The Role of Early Clinical Features and Laboratory Tests of Influenza A and B in Early Identification

作　　者：高明月[1] 陈晓莉 张强[1] GAO Mingyue;CHEN Xiaoli;ZHANG Qiang(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西公共卫生学院/四川大学华西第四医院流行病与卫生统计学系,成都610041

出　　处：《预防医学情报杂志》2021年第5期729-735,共7页Journal of Preventive Medicine Information

摘　　要：目的探讨流感早期临床特征以及实验室检测在甲、乙型流感病毒感染患者中的临床价值。方法选取2018-12/2019-02在四川大学华西医院就诊并进行流感病毒抗原检测的2 950名患者,比较流感患者和非流感患者的性别构成比、年龄分布状态、临床症状和急诊首次实验室检验结果。采用SPSS 25.0和MedCalc软件进行统计分析,采用χ2检验、Kruskal-Wallis H检验和多因素Logistic回归分析流感病毒感染相关因素,ROC曲线评价相关因素对流感病毒感染的诊断价值。结果选取流感病毒抗原检测患者2 950例,其中甲型流感949例,乙型流感285例。乙流阳性检出率在男性和年龄10岁以下较高,流感患者高热比例(88.2%)高于非流感(85.5%),且甲流患者发热比例(73.84%)高于乙流患者(66.2%)。与非流感患者比较,流感患者出现腹泻的比例高,出现咳嗽、咳痰、畏寒的比例低。甲流患者与非流感患者比较,NEUT、LY更高,WBC计数、间接胆红素较低(P<0.05)。乙流患者与非流感患者比较,LY、球蛋白更高,APTT较低(P<0.05)。ROC曲线显示:年龄、WBC、NEUT、LY、间接胆红素、球蛋白对流感病毒感染都有一定的诊断效能,但都不理想,曲线下面积(AUC)在0.5~0.6,球蛋白诊断流感的AUC最大为0.554(95%CI:0.521~0.587),其敏感度和特异度分别为59.47%和49.81%,最佳截断值是30.5。多因素Logistic回归显示:年龄(OR=0.817,95%CI:0.713~0.936)、NEUT(OR=1.043,95%CI:1.007~1.080)、球蛋白(OR=1.026,95%CI:1.003~1.051)与是否感染流感病毒有关(P<0.05)。结论高热、干咳、畏寒、腹泻等临床症状,以及WBC、NEUT、LY、间接胆红素、球蛋白等实验室检测指标与流感病毒感染密切相关,可能给甲型或乙型流感病毒感染的诊断提供新的线索。Objective To explore the role of early clinical features and laboratory tests of influenza A and B in early identification of patients with influenza A or B virus. Methods Totally, 2 950 patients with influenza virus antigen detection were selected from December 2018 to February 2019 in West China Hospital of Sichuan University.Gender composition ratio, age distribution,clinical symptoms and the first laboratory test results of emergency department were compared between the influenza patients and the non-influenza patients. SPSS 25.0 and Med Calc software were used for statistical analysis. chi-square tests, Kruskal-Wallis H tests and multivariate Logistic regression models were used to analyze the factors related to influenza virus infection. ROC curve was used to evaluate the diagnostic value of related factors for influenza virus infection. Results Totally,2 950 patients were tested for influenza virus antigen,including 949 patients with influenza A and 285 patients with influenza B. The positive rate of influenza B was higher in males and children under 10 years old. The proportion of influenza patients with high fever(88.2%) was higher than that of non-influenza patients(85.5%), and the proportion of fever in influenza A(73.84%) was higher than that in influenza B(66.2%). Patients with influenza had higher proportion of diarrhea, but the proportion of cough, phlegm and chills was lower. Compared with non-influenza patients, NEUT、 LY count in influenza A group was higher, whereas WBC count and Indirect bilirubin level was lower. Compared with non-influenza patients,LY count and globulin level in influenza B group was higher, but APTT level was lower. ROC curve showed that age,WBC, NEUT, LY, indirect bilirubin and globulin all had certain diagnostic efficacy for influenza virus infection,but none was ideal. AUC ranged from 0.5 to 0.6,the maximum AUC for globulin diagnosis of influenza was 0.554(95% CI: 0.521-0.587). The sensitivity and specificity were59.47% and 49.81%, and the cut-off value of globulin was

关 键 词：甲型流行性感冒 乙型流行性感冒 临床症状 实验室检测 

分 类 号：R181[医药卫生—流行病学]