摘要
目的了解北京地区“流感样疾病”的病原谱与抗菌药物治疗及预后的关系。方法采用前瞻性队列研究方法，选取符合卫生部流感样疾病定义的发热门诊患者，留取咽分泌物进行细菌学和病毒学检测，调查患者的年龄、基础疾病、呼吸道症状、肺外表现和实验室检查，分析治疗和预后的关系。采用SPSS10．0统计软件进行汇总分析。计量资料采用t检验或秩和检验，计数资料采用χ^2检验，退热时间的影响因素采用Cox回归分析。结果2006年12月至2007年4月共入选“流感样疾病”患者476例，最终资料完整的454例纳入分析。除副流感嗜血杆菌外，流感病毒是最主要的致病原（197例，43．4％），其他病原体少见。454例患者的平均年龄为（33±13）岁，男：女为1．1：1，1年内有流感疫苗接种史的24例（5．3％），接受抗菌药物治疗的288例（63．4％），无接受奥司他韦或金刚烷胺等抗流感病毒药物的患者。与流感病毒阴性组相比，流感病毒阳性组年龄较大、基础疾病较多，咳嗽、咽痛和全身症状的比例较高，但无统计学意义。流感病毒阳性组表现为流感综合征（体温≥39℃，同时伴有咳嗽、咽痛、头痛或全身肌肉酸痛）的比例显著高于流感病毒阴性组。流感病毒阳性组197例中用抗菌药物治疗的132例（67．0％），抗菌药物治疗组外周血白细胞总数、中性粒细胞比例、血小板计数高于未用抗菌药物组；应用抗菌药物组的医疗费用比不用抗菌药物组约高1倍，但平均退热时间、症状缓解时间及复诊率无统计学意义。Cox回归分析结果显示，白细胞和中性粒细胞百分比增高是退热时间延长的独立危险因素（OR值分别为1．049和1．014），但抗生素使用不影响退热时间。结论在冬春季节北京地区“流感样疾病”的主要病原体是流感病毒；对于单纯“流感样疾病”，抗菌
Objective To study the etiology of influenza-like illness （ILI） in Beijing, and to investigate the impact of antibiotic treatment on outcomes. Methods This was a prospective cohort study. Patients with diagnosis of influenza-like illness were prospectively enrolled for study of bacterial and viral pathogens. Demographic characteristics, underlying diseases, respiratory and extrapulmonary symptoms, laboratory tests were also collected for analysis of relationship between drug therapy and outcomes. Results A total of 476 cases were enrolled between Dec. 2006 and Apr. 2007, of whom 454 cases were used for analysis. Influenza virus was the most common pathogen（ n = 197,43.4% ）, with other pathogens rarely seen. The mean age of the patients was （33 ±13） years, and the ratio of male to female was 1. l： 1. Twenty four patients （5.3%） received influenza vaccine. The rate of antibiotic prescription after onset of illness was 63.4% , but none received antiviral drugs such as Oseltamivir and amantadine, Compared with influenzanegative patients, patients with influenza were older, had more underlying diseases and had greater severity of symptoms such as cough, sore throat, headache and myalgia （ but with no statistical differences）. Theinfluenza syndrome （T≥39 ℃ plus cough, sore throat and headache or myalgia） was more common in the influenza group compared to the influenza-negative patients （ P 〈 0. 05 ）. The ratio of antibiotic prescription was 67% in the influenza group, and the total white blood cell and platelet count, percentage of neutrophils were higher in antibiotic treatment patients compared with non-antibiotic treatment patients （P 〈 0.01 ）. The cost in patients who received antibiotics was twice as much as non-antibiotic treatment patients （ P 〈 0.05 ）, but the defervescence time and respiratory symptom alleviation time did not differ. Cox regression analysis showed that the total white blood count and the differentials （ OR value 1. 049 and 1. 014 ,respectively
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2008年第7期483-487,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家科技攻关计划基金资助项目（2004BA519A72）
国家高技术研究发展计划（863计划）基金资助项目（2006AA022452）
关键词
正黏病毒科
抗菌药
医疗费用
流感样疾病
Orthomyxoviridae
Anti-bacterial agents
Fees, medical
Influenza-like illness
