中国10省(市)流感成年人住院病例的临床特征及重症危险因素分析

姜慧; 于德山; 阮峰; 徐闻; 黄婷; 李玲; 王开利; 刘社兰; 张恒娇; 贾平东; 杨鹏; 彭质斌; 郑建东; 冯录召; 余宏杰

Abstract

姜慧,于德山,阮峰,徐闻,黄婷,李玲,王开利,刘社兰,张恒娇,贾平东,杨鹏,彭质斌,郑建东,冯录召,余宏杰.中国10省(市)流感成年人住院病例的临床特征及重症危险因素分析[J].Chinese journal of Epidemiology,2015,36(3):216-221

中国10省(市)流感成年人住院病例的临床特征及重症危险因素分析

Clinical characteristics of adult influenza inpatients in ten provinces in China and analysis of severe risk factors

Received:November 05, 2014

DOI：10.3760/cma.j.issn.0254-6450.2015.03.006

KeyWord: 严重急性呼吸道感染流感住院病例成年人危险因素

English Key Word: Severe acute respiratory infection Influenza Inpatient cases Adult Risk factors

FundProject:中美新发和再发传染病合作项目

Author Name	Affiliation	E-mail
Jiang Hui	Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Yu Deshan	Gansu Provincial Center for Disease Control and Prevention
Ruan Feng	Zhuhai Municipal Center for Disease Control and Prevention
Xu Wen	Yunnan Provincial Center for Disease Control and Prevention
Huang Ting	Sichuan Provincial Center for Disease Control and Prevention
Li Ling	Fujian Medical University Union Hospital
Wang Kaili	Heilongjiang Provincial Center for Disease Control and Prevention
Liu Shelan	Zhejiang Provincial Center for Disease Control and Prevention
Zhang Hengjiao	Hunan Provincial Center for Disease Control and Prevention
Jia Pingdong	The Center Hospital of Jinan
Yang Peng	Beijing Municipal Center for Disease Control and Prevention
Peng Zhibin	Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Zheng Jiandong	Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Feng Luzhao	Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China	fenglz@chinacdc.cn
Yu Hongjie	Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China

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Abstract:

目的了解中国10省(市)严重急性呼吸道感染(SARI)住院病例哨点监测纳入的流感成年人住院病例的临床特征及重症危险因素。方法对2009年12月至2014年6月中国10省(市)SARI哨点监测医院纳入的符合SARI定义的≥15岁病例进行流行病学和临床信息调查,采集呼吸道标本进行流感病毒核酸检测。按检测结果将病例分为流感住院组和非流感住院组,分析两组人口统计学信息、临床和流行病学特征,并分析重症危险因素。结果 10家哨点医院共纳入3 071例SARI成年人病例,其中实验室确诊240例(7.8%),以A(H1N1)pdm2009和A(H3N2)亚型流感病毒为主。病例年龄M为63岁,≥65岁老年人占47.1%。144例(60.0%)患有至少1种慢性基础性疾病,流感病例肺气肿比例(7.9%)高于非流感病例(3.8%),差异有统计学意义(χ²=3.963,P=0.047)。19.4%的流感育龄妇女为孕妇,240例流感病例中仅有1.1%在过去一年接种过流感疫苗。流感住院病例中咽痛、呼吸困难所占比例高于非流感住院病例。17.5%的流感病例收入重症监护室治疗,与非流感住院病例间的差异无统计学意义(P=0.160)。23.1%的流感病例在发病后使用了抗病毒药物治疗,高于非流感住院组(4.8%),差异有统计学意义(P<0.001)。流感住院病例中41.5%出现并发症,病毒性肺炎比例明显高于非流感组(P<0.001)。危险因素分析显示,发病入院时间>7 d(RR=1.673,95%CI:1.071～2.614)、患有哮喘(RR=15.200,95%CI:1.157～199.633)、免疫抑制疾病(RR=5.250,95%CI:1.255～21.960)、怀孕(RR=21.000,95%CI:1.734～254.275)是流感重症的危险因素。结论成年人流感住院病例主要集中在≥65岁组,流感疫苗接种率极低、抗病毒药物使用不足,应推荐孕妇、老年人、慢性病病例等高危人群每年进行流感疫苗预防接种,流感住院病例应及早应用抗病毒药物。

English Abstract:

Objective To identity the clinical characteristics and severe case risk factors for the adult inpatient cases confirmed of influenza monitored by the sentinel surveillance system for severe acute respiratory infection (SARI) inpatient cases in ten provinces in China. Methods Epidemiology and clinical information surveys were conducted for adult cases (≥15 year old) consistent with SARI case definition,who were monitored by SARI sentinel hospitals in ten cities in China from December 2009 to June 2014,with their respiratory tract specimens collected for influenza RNA detection. Adult SARI cases were classified into influenza inpatient group and outpatient group by the detection outcomes,analyzing their demographic information,clinical and epidemiology characteristics respectively,in addition to risk factors for severe inpatient cases. Results 3 071 adult SARI cases were recruited from ten hospitals,including 240(7.8%) cases of laboratory-confirmed influenza,most of them being A(H1N1)pdm2009 and A(H3N2) sub-types. Age M of the included influenza cases was 63 year old,47.1% of them being ≥65 seniors. 144(60.0%) cases of the influenza inpatients suffered from at least one chronic underlying condition,and the proportion of emphysema (7.9%) was higher than non-influenza inpatient cases(3.8%),being statistically significant(χ²=3.963,P=0.047). 19.4% of the women of childbearing age infected of influenza were in pregnancy,and only 1.1% of the 240 influenza cases had been vaccinated against influenza. The proportion of sore throat and dyspnea found among influenza inpatients was higher than inpatients without influenza. 17.4% of the influenza cases were accepted into ICU for treatment,with no statistical significance with non-influenza inpatient cases (P=0.160). 23.1% of the influenza inpatients received an antiviral drug therapy,a figure higher than the non-influenza inpatient cases(4.8%)(P<0.001). 41.5% of the inpatients developed complications,with the proportion of viral pneumonia significantly higher than the non-influenza inpatient cases(P<0.001). Asthma (RR=15.200,95%CI:1.157- 199.633),immunosuppressive diseases(RR=5.250,95%CI:1.255-21.960),pregnancy(RR=21.000,95%CI:1.734-254.275),time interval from onset to admission less 7 days(RR=1.673,95%CI:1.071-2.614) were identified as risk factors of severely-ill influenza cases. Conclusion It was found that adult influenza inpatients were mostly ≥65 year old seniors. The influenza vaccination rate among the influenza cases was very low,and antivirus drugs were used less than necessary. In this regard,influenza vaccination was recommended for high risk groups of pregnant women,seniors and chronic disease patients on annual basis,while influenza inpatients were advised to use antiviral drugs as early as possible.

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