摘要
目的分析重症H1N1流感患者合并侵袭性肺曲霉病(IPA)的危险因素、临床特征和结局指标,为早期诊断曲霉感染、改善预后提供依据。方法收集四川大学华西医院2018年12月至2019年3月诊断为重症H1N1流感合并IPA患者64例,并选取同期年龄及性别相匹配的单纯重症H1N1流感患者50例。分析两组患者的基础信息、起病症状、实验室检查、影像学特征、微生物学资料及预后相关指标。结果合并IPA使得重症H1N1流感患者的死亡率明显升高(51.6%比32.0%,P=0.036)。重症H1N1流感患者曲霉感染的发生与患者的年龄、性别、基础疾病、糖皮质激素的使用以及CD4^(+)T细胞计数无关。相较于单纯重症H1N1流感患者,合并IPA组患者入院时血清C反应蛋白水平[(125.0±88.8)比(86.1±80.1)mg/L,P=0.038]和白细胞介素-6水平[(148.7±154.2)比(81.7±110.2)μg/L,P=0.039]均显著升高。合并IPA组患者以发热(81.3%比64.0%,P=0.038)和呼吸困难(51.6%比24.0%,P=0.003)为主要起病症状,肺部影像学多表现为在磨玻璃影基础上出现以结节为主要特征的改变。结论重症H1N1流感患者是否合并IPA与患者基础情况无关,而是可能与病毒感染继发的肺部过度炎症反应相关。
Objective To analyze risk factors, clinical features and outcome factors of invasive pulmonary aspergillosis(IPA) in severe H1N1 patients so as to achieve early diagnosis and improve prognosis. Methods Fifty severe H1N1 influenza patients with IPA admitted to West China Hospital and 64 severe H1N1 influenza patients in the same period matched by age and gender were collected. Patient characteristics, laboratory examinations, radiological imaging,microbiology data and prognostic indicators were involved into analysis. Results The mortality of severe H1N1 influenza patients with IPA was significantly higher than those without IPA(51.6% vs. 32.0%, P=0.036). However, the incidence of IPA in severe H1N1 influenza patients was not related with the patient’s age, gender, underlying disease,glucocorticoid use and CD4^(+) T cell count. Serum C-reactive protein level [(125.0±88.8) vs.(86.1±80.1) mg/L, P=0.038] and interleukin-6 level [(148.7±154.2) vs.(81.7±110.2) μg/L, P=0.039] of severe H1N1 influenza patients with IPA were significantly higher than those without IPA. Besides, more patients presented with fever(81.3% vs. 64.0%, P=0.038) and dyspnea(51.6% vs. 24.0%, P=0.003) in severe H1N1 patients with IPA. The radiological imaging of severe H1N1 patients with IPA were mostly characterized by combining with nodular changes on the basis of ground-glass opacity. Conclusion The occurrence of IPA in severe H1N1 influenza patients may be related with pulmonary excessive inflammatory response secondary to viral invasion rather than basic condition of the patient.
作者
段伊珊
陈雨莎
梁斌苗
欧雪梅
DUAN Yishan;CHEN Yusha;LIANG Binmiao;OU Xuemei(Department of Respiratory and Critical Care Medicine,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2021年第5期310-314,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
国家自然科学基金(31671189)
四川省科技厅重点研发项目(2018SZ0109)。
关键词
侵袭型肺曲霉病
重症H1N1流感
预后
临床特征
Invasive pulmonary aspergillosis
Severe H1N1 influenza
Prognosis
Clinical features
