摘要
目的了解新型甲型H1N1流感继发肺部感染的病原菌特点,分析继发肺部感染的相关因素。方法选取2018年5月-2019年5月在本院就诊的新型甲型H1N1流感患者412例,检查继发肺部感染发生情况;对患者进行问卷调查,采用多因素非条件Logistic回归分析法分析新型甲型H1N1流感继发肺部感染的影响因素。结果412例新型甲型H1N1流感患者中继发肺部感染137例,占33.25%。其中细菌感染91例,占22.09%;真菌感染46例,占11.17%。单因素分析显示,年龄、营养状况、是否伴有基础疾病、体质量指数、是否吸烟、空腹血糖值、淋巴细胞数、是否为孕妇/产妇、机械通气时间、早期是否给予抗菌和抗病毒治疗及APACHEⅡ评分为新型甲型H1N1流感患者继发肺部感染相关因素(均P<0.05);多因素Logistic回归分析显示,体质量指数≥24 kg/m2、孕妇/产妇、早期未接受抗菌及抗病毒治疗、APACHEⅡ评分≥20分是新型甲型H1N1流感患者继发肺部感染的独立危险因素。结论新型甲型H1N1流感患者易继发肺部感染,应特别关注体质量指数≥24 kg/m2、孕妇/产妇、APACHEⅡ评分≥20分的患者,及时给予抗菌及抗病毒治疗,减少肺部感染的发生。
Objective To ascertain the characteristics of pathogens causing a pulmonary infection secondary to novel influenza A(H1 N1)and to analyze the factors related to development of that secondary pulmonary infection.Methods Subjects were a total of 412 patients with novel influenza A(H1 N1)who were seen at this Hospital from May 2018 to May 2019.The incidence of a secondary pulmonary infection was examined.Peripheral venous blood from routine tests was examined by an automated blood cell analyzer.The level of high-sensitivity C-reactive protein in fasting venous blood in the morning was measured using immunoturbidimetry.Sputum specimens and tracheal secretions were collected for sputum smear microscopy and sputum culture.All patients underwent a chest X-ray or CT scan.Patients were surveyed,and multivariate unconditional logistic regression analysis was used to analyze factors influencing the development of a pulmonary infection secondary to novel influenza A(H1 N1).Results Among 412 patients infected with novel influenza A(H1 N1),137(33.25%)had a secondary pulmonary infection.Of those,91(22.09%)had a bacterial infection and 46(11.17%)had a fungal infection.The WBC count was normal in 186 patients(45.15%),decreased in 146(35.44%),and increased in 80(19.42%).One hundred and nineteen patients(28.88%)had lymphocytopenia.High sensitivity C-reactive protein was elevated in 290 patients(70.39%).Imaging studies indicated that 360 patients(87.38%)had multilobed lung involvement,including 335 with middle and lower lung involvement(81.31%),300 with subpleural involvement(72.82%),and 43 patients with single lung involvement(10.44%).Univariate analysis indicated that age,nutritional status,underlying diseases,body mass index,smoking,fasting blood glucose,lymphocyte count,being a pregnant/parturient woman,time on mechanical ventilation,early antibacterial and antiviral therapy,and the APACHE II score were factors related to development of a pulmonary infection secondary to novel influenza A(H1 N1)(P<0.05).Multivariate logistic regression analysis indicated that a body mass index≥24 kg/m2(OR=3.281,95%CI=1.327-8.114),being a pregnant/parturient woman(OR=4.077,95%CI=1.754-9.155),not receiving antibacterial(OR=4.714,95%CI=1.616-13.749)or antiviral therapy early(OR=4.609,95%CI=1.571-13.524),and an APACHE II score≥20 points(OR=4.592,95%CI=1.872-11.263)were independent risk factors for a pulmonary infection secondary to novel influenza A(H1 N1).Conclusion Patients infected with novel influenza A(H1 N1)are prone to development of a secondary pulmonary infection.Special attention should be paid to patients with a body mass index≥24 kg/m2,pregnant/parturient,and patients with an APACHE II score≥20 points,and timely antibacterial and antiviral therapy should be administered to reduce the incidence of pulmonary infection.
作者
苏维
李明
马士恒
李伟
SU Wei;LI Ming;MA Shi-heng;LI Wei(Department of Laboratory Medicine,Affiliated Hospital of Hebei University,Baoding,Hebei 071000,China;Department of Infectious Diseases,Affiliated Hospital of Hebei University)
出处
《中国病原生物学杂志》
CSCD
北大核心
2021年第1期86-89,共4页
Journal of Pathogen Biology
