重症社区获得性肺炎患者人巨细胞病毒活动性感染状况以及危险因素分析  

Incidence and risk factors of active human cytomegalovirus infection in patients with severe community-acquired pneumonia

作　　者：张志辉 伍湛 张洁容 梁嘉祺 许敏敏 陈思蓓 刘学松 徐永昊 桑岭 何为群 黎毅敏 刘晓青 Zhang Zhihui;Wu Zhan;Zhang Jierong;Liang Jiaqi;Xu Minmin;Chen Sibei;Liu Xuesong;Xu Yonghao;Sang Ling;He Weiqun;Li Yimin;Liu Xiaoqing(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,State Key Laboratory of Respiratory Diseases,Guangzhou 510120,China)

机构地区：[1]呼吸疾病国家重点实验室广州呼吸健康研究院广州医科大学附属第一医院呼吸与危重症医学科,广州510120

出　　处：《中华实验和临床病毒学杂志》2021年第4期389-394,共6页Chinese Journal of Experimental and Clinical Virology

基　　金：国家科技重大专项(2017ZX10204401);国家自然科学基金(81970071,82070084);广州医科大学高水平大学临床研究培育项目(B185004064);广州医科大学学生课外学术科技立项项目(2020A012,2021A016)。

摘　　要：目的:探讨重症社区获得性肺炎患者人巨细胞病毒(human cytomegalovirus,HCMV)活动性感染状况以及相关危险因素。方法:连续筛选2019年3月1日至2020年6月1日期间在广州医科大学附属第一医院呼吸重症监护室(respiratory intensive care unit,RICU)中需呼吸支持且确诊为重症社区获得性肺炎的患者,按照是否存在HCMV活动性感染分为HCMV活动性感染组20例和HCMV非活动性感染组95例,比较分析两组人口学资料、实验室检测指标和临床结局,并应用Logistic回归分析HCMV活动性感染的危险因素。结果:115例需呼吸支持的重症社区获得性肺炎患者中有20例被证实存在HCMV活动性感染,HCMV活动性感染发生率为17.4%。HCMV活动性感染组患者肺炎严重程度评分(pneumonia severity index,PSI)和抑制性T淋巴细胞(suppressor T lymphocytes,Ts)百分比水平均高于对照组,差异均有统计学意义(Z=2.432,P=0.015;Z=2.036,P=0.042),而淋巴细胞数、单核细胞数、血乳酸和血小板水平则均低于对照组,差异均有统计学意义(P<0.05)。HCMV活动性感染组患者输血率高于对照组,差异有统计学意义(χ^(2)=3.941;P=0.047)。PSI和Ts百分比水平上升是HCMV活动性感染发生的独立危险因素(OR=1.03,95%CI:1.01~1.05;OR=1.06,95%CI:1.00~1.11;P<0.05)。HCMV活动性感染组患者RICU住院天数、并发症发生率以及90天全因病死率均高于对照组,差异均有统计学意义(P<0.05)。结论:HCMV活动性感染在重症社区获得性肺炎患者中发生率偏高,与多种不良临床预后相关,PSI和Ts细胞水平是其独立危险因素。Objective To investigate the incidence and risk factors of active human cytomegalovirus(HCMV)infection in patients with severe community-acquired pneumonia.Methods Patients who required respiratory support and were diagnosed with severe community-acquired pneumonia in the respiratory intensive care unit(RICU)of the First Affiliated Hospital of Guangzhou Medical University from March 1,2019 to June 1,2020 were consecutively screened and divided into active HCMV infection group(20 cases)and non-active HCMV infection group(95 cases)based on whether a patient has active HCMV infection or not.Differences in demographic data,laboratory findings,and clinical outcomes were compared between the two groups.Moreover,logistic regression was applied to analyze risk factors for active HCMV infection.Results The 20 of 115 patients with severe community-acquired pneumonia requiring respiratory support were confirmed to have active infection with HCMV,with a prevalence of active HCMV infection of 17.4%.The pneumonia severity index(PSI)and suppressor T lymphocytes(Ts)in active HCMV infection group were higher than that of the control group,and all the differences were statistically significant(Z=2.432,P=0.015;Z=2.036,P=0.042);whereas lymphocytes,monocytes,blood lactate,and platelet levels were lower than those of the control group,and all the differences were statistically significant(P<0.05).Patients with active HCMV infection had a higher transfusion rate than the control group,and the differences were statistically significant(χ^(2)=3.941;P=0.047).Increasing levels of PSI and Ts percentage were independent risk factors for active HCMV infection(OR=1.03,95%CI:1.01~1.05;OR=1.06,95%CI:1.00~1.11;P<0.05).RICU length of stay,complication rates,and 90-day all-cause mortality were higher in the active HCMV infection group than the control group,and all the differences were statistically significant(P<0.05).Conclusions Active HCMV infection is highly prevalent in patients with severe community-acquired pneumonia and associated with sev

关 键 词：人巨细胞病毒 活动性感染 重症社区获得性肺炎 发生率 危险因素 

分 类 号：R47[医药卫生—护理学]