间质性肺疾病合并流感病毒感染患者的临床影像学特征及治疗分析  

Analysis of clinical radiographic features and treatment of interstitial lung disease patients infected with influenza virus

作　　者：刘寅[1] 姜涵毅[1] 胡晓菡[2] 赵婷婷[1] 曹敏[1] 演欣 肖永龙[1] 何健[3] 戚荣丰 苏欣 LIU Yin;JIANG Hanyi;HU Xiaohan;ZHAO Tingting;CAO Min;YAN Xin;XIAO Yonglong;HE Jian;QI Rongfeng;SU Xin(Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,P.R.China;Department of Laboratory Medicine,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,P.R.China;Department of Nuclear Medicine,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,P.R.China;Department of Medical Imaging,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院呼吸与危重症医学科,南京210008 [2]南京大学医学院附属鼓楼医院医学检验科,南京210008 [3]南京大学医学院附属鼓楼医院核医学科,南京210008 [4]南京大学医学院附属鼓楼医院医学影像科,南京210008

出　　处：《中国呼吸与危重监护杂志》2025年第3期172-178,共7页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家自然科学基金(82270019);南京鼓楼医院临床研究专项资金(2023-LCYJ-MS-18)。

摘　　要：目的分析间质性肺疾病(interstitial lung disease,ILD)合并流感病毒感染患者的临床影像学特征及治疗。方法分析2023年10月—2024年1月期间南京鼓楼医院呼吸与危重症医学科收治的ILD住院患者临床资料。根据流感病毒核酸检测结果,将ILD患者分为流感病毒阳性组与流感病毒阴性组,对两组临床、影像学特征及治疗情况进行比较。结果73例接受流感病毒核酸检测的ILD患者中23例(31.5%)合并流感病毒感染,其中甲型流感病毒感染21例,乙型流感病毒感染2例,男5例,女18例,年龄(64.7±7.8)岁。其中主要临床表现为咳嗽(23例,100.0%)、咳痰(23例,100.0%)、气喘(20例,87.0%)和发热(17例,73.9%),与流感病毒阴性组相比,流感病毒阳性组发热症状更多见(P<0.05),外周血淋巴细胞计数更低(P<0.05),而白细胞、中性粒细胞计数、乳酸脱氢酶、肌酸激酶、红细胞沉降率、C反应蛋白、降钙素原、白细胞介素6和氧合指数等指标两组差异无统计学意义(P>0.05)。流感病毒阳性组胸部CT磨玻璃影较流感病毒阴性组更多见(P<0.05)。流感病毒阳性组10例患者(43.5%)合并曲霉感染,较流感病毒阴性组更多见(P<0.05)。合并曲霉感染ILD患者胸部CT分型以普通型间质性肺炎为主,蜂窝影较流感病毒阳性组中未合并曲霉患者多见(P<0.05)。22例患者(95.7%)接受抗流感病毒治疗,其中20例(87.0%)应用奥司他韦,5例(21.7%)应用玛巴洛沙韦,4例(17.4%)联合应用帕拉米韦。17例ILD患者(73.9%)既往接受糖皮质激素治疗,17例患者均未对基础激素用量进行调整;9例患者(39.1%)既往应用免疫抑制剂治疗,2例感染流感病毒后予以停用免疫抑制剂。4例感染流感病毒患者(17.4%)出现ILD急性加重,较流感病毒阴性组差异无统计学意义(P>0.05)。结论ILD患者感染流感病毒后发热症状多见,淋巴细胞降低,胸部CT磨玻璃影多见,其中以蜂窝影为特征的普通型间质性肺炎分型的ILD�Objective To analyze the clinical radiographic features and treatment of interstitial lung disease(ILD) inpatients infected with influenza virus.Methods The clinical data of ILD patients with influenza in Nanjing Drum Tower Hospital from October 2023 to January 2024 were collected.According to each patient results of influenza nucleic acid detection,they were divided into an influenza infection group and a non-infection group.Results A total of73 patients received influenza nucleic acid detection were enrolled,23 cases including 5 males and 18 females were positive.Twenty-one cases were infected with influenza A virus,2 cases were infected with influenza B virus.The median age of influenza positive patients was 64.7±7.8 years.Cough(23 cases,100.0%),sputum(23 cases,100.0%),wheezing(20 cases,87.0%) and fever(17 cases,73.9%) were the most common symptoms of the patients infected with influenza.Compared with the non-infection patients,fever was more common in the influenza infection group(P<0.05).Laboratory examination indicated that lymphocytopenia were detected in the influenza infection patients.There was no statistical difference in the level of white blood cell count,neutrophil count,lactate dehydrogenase,creatine kinase,erythrocyte sedimentation rate,C-reactive protein,calcitonin,interleukin-6 and oxygenation index.Ground glass opacity in the influenza virus infection group was more common than that in the non-infection group(P<0.05).Ten ILD patients infected with influenza virus(43.5%) were co-infected with Aspergillus.The chest CT type of ILD patients with Aspergillus infection was usual interstitial pneumonia(UIP).Honeycombing was more common than those without Aspergillus infection group(P<0.05).Twenty-two patients(95.7%) received antiviral treatment,of which 20 patients(87.0%) were treated with oseltamivir,5 patients(21.7%) were treated with mabaloxavir,and 4 patients(17.4%) were treated combined with paramivir.Seventeen patients(73.9%) were previously treated with glucocorticoids,and 16 patients did not

关 键 词：间质性肺病 流感病毒 临床特征 放射影像学 

分 类 号：R56[医药卫生—呼吸系统]