成人呼吸道合胞病毒下呼吸道感染临床特征和预后分析  

Clinical features and prognosis of respiratory syncytial virus infections of lower respiratory tracrt in adult patients

作　　者：孙国磊 李丽娟[2] SUN Guo-lei;LI Li-juan(Department of Critical Care and Emergency of Tianjin Jinnan Hospital,Tianjin 300052,China)

机构地区：[1]天津市津南医院重症医学-急诊科,天津300052 [2]国家呼吸疾病临床研究中心中日友好医院呼吸中心呼吸与危重症医学科二部,北京100029

出　　处：《中国实用内科杂志》2021年第7期593-599,共7页Chinese Journal of Practical Internal Medicine

基　　金：国家科技支撑计划(2015BAI12B11);北京市科技计划课题(D151100002115004)。

摘　　要：目的分析成人呼吸道合胞病毒(RSV)下呼吸道感染患者的临床特征及预后。方法以2016年8月至2019年11月入住中日友好医院呼吸科或重症监护病房(ICU)的RSV核酸阳性患者148例为研究对象,同时取甲型流感病毒(FluA)核酸阳性的下呼吸道感染患者266例为对照组,根据是否合并免疫功能低下,分为免疫功能正常组和免疫功能低下组。对2组患者的年龄、性别、基础疾病、症状、疾病严重程度、影像学表现、病原学特征、抗菌药物应用情况、住院病死率等情况等进行比较分析,并应用logistic回归分析探讨RSV下呼吸道感染患者的预后因素。结果1月份至3月份、11月份至12月份是发病高峰期,占所有RSV感染患者的79.7%,占所有FluA患者的89.9%。在RSV下呼吸道感染中11例(7.4%)患者没有任何基础疾病,46例(31.1%)患者合并呼吸衰竭,28例(18.9%)患者给予有创机械通气治疗,22例(14.9%)患者在住院期间死亡。RSV组合并免疫功能低下和吸烟的比例、合并发热和呼吸困难的比例、乳酸脱氢酶水平、抗真菌药物的比例、CURB65评分大于1分的比例、合并呼吸衰竭、合并机械通气、体外膜肺氧合(ECMO)、住ICU比例和住院病死率均低于FluA组(均P<0.05),其合并基础疾病、淋巴细胞水平和CT合并斑片状渗出、网格、蜂窝和支气管壁增厚的比例高于FluA组(均P<0.05)。RSV下呼吸道感染中合并其他病原体感染66例(44.6%),FluA组继发感染的比例高于RSV组(P<0.001)。logisitic回归分析示,有创机械通气和持续淋巴细胞减低为免疫功能正常宿主RSV下呼吸道感染患者预后的独立预测因子,呼吸衰竭为免疫功能低下宿主RSV感染患者预后的独立预测因子。结论成人住院的RSV下呼吸道感染患者多合并基础疾病,住院病死率和继发感染比例低于FluA,若合并呼吸衰竭、持续淋巴细胞减低、有创机械通气提示预后不佳。Objective To explore the clinical features and prognostic factors of lower respiratory tract infections with respiratory syncytial virus in adults.Methods A total of 148 patients admitted to hospital for pneumonia were enrolled from China-Japan Friendship hospital between August 2016 and November 2019,266 cases of influenza A virus(FluA)nucleic acid positive patients with lower respiratory tract infection were selected as the control group.Patients were divided into two groups depending on the status of immune function.Characteristics including age,gender,underlying diseases,corticosteroids,symptoms,disease severity,imaging manifestations,etiology,antimicrobial drug,glucocorticoids and other immunosuppressants,in-hospital mortality between the groups were compared,and the prognostic factors of RSV infections were investigated using logistic regression.Results The peak incidence of RSV infection time was in January,February,March,November and December,accounting for 79.7%of all RSV infected cases and 89.9%of all FluA cases.Among the RSV lower respiratory tract infections,11(7.4%)patients had no underlying diseases,46(31.1%)patients had respiratory failure,28(18.9%)patients received invasive mechanical ventilation,and 22(14.9%)patients died during hospitalization.Cases with Flu A infection were remarkably correlated with higher immunocompromised patients and the proportion of smoking,fever and dyspnea,lactate dehydrogenase levels,antifungal drugs,the proportion of patients with CURB65 score>1,respiratory failure,mechanical ventilation,Extracorporeal Membrane Oxygenation(ECMO),ICU stay and in-hospital mortality than that of RSV infection.The proportion of underlying diseases,CT with ground-glass opacity,honeycomb or reticular pattern and bronchial wall thickening in RSV infection group were higher than that in Flu A group.There were 66 cases(44.6%)with co-infections in the lower respiratory tract of RSV.The proportion of nosocomial infection in Flu A group was higher than that in RSV group(P<0.001).Logistic regressi

关 键 词：呼吸道合胞病毒 呼吸道感染 疾病特征 预后 

分 类 号：R373.1[医药卫生—病原生物学]