10省市严重急性呼吸道感染成人住院病例临床特征及重症危险因素分析

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摘要目的分析10省市严重急性呼吸道感染（SARI）病例哨点监测纳入的成人住院病例的人口统计学和临床特征,探讨影响重症和死亡的危险因素。方法对2009年12月-2014年6月全国10省市住院严重急性呼吸道感染（SARI）哨点监测医院纳入的≥15岁的成人SARI病例进行流行病学和临床信息调查,按照疾病临床严重性将SARI成人病例分为轻症住院病例和重症住院病例,分析两组病例的人口统计学信息、临床和流行病学特征,并分析SARI住院重症病例发生的危险因素。结果10家哨点医院共纳入3071例SARI成人病例,年龄中位数为58岁,≥65岁老年人占39.69%。收入重症监护室治疗的重症病例和死亡病例共432例（14.07%）,轻症病例2639例（85.93%）。重症和死亡病例中男性比例较高,≥65岁老年患者、患有基础性疾病的病例及孕妇的比例显著高于轻症病例（P<0.001）。发热（96.44%）、咳嗽（85.47%）是成人SARI病例最常见的临床症状,30%的病例出现并发症。5.95%的SARI成人病例发病后应用了抗病毒药物治疗;流感病毒检测阳性的SARI病例240例（7.82%）,以A(H1N1)pdm和A(H3N2)亚型流感为主。重症病例危险因素的回归分析显示,男性、患有慢性基础性疾病、发病-入院时间>7天等是重症的危险因素,肺炎是病例死亡的危险因素。结论SARI成人住院病例主要集中在男性,≥65岁的老年人。流感病例的抗病毒药物使用不足,建议流感住院患者及早使用抗病毒药物。引发SARI的主要病原体尚未可知,建议进行呼吸道多病原体检测。

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	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

关键词 ：严重急性呼吸道感染, 流感, 住院病例, 成人, 危险因素

Abstract：ObjectiveTo understand clinical characteristics and demographics of hospitalized severe acute respiratory illnesses (SARI) patients in adults and to analyze risk factors associated with severe cases and death. MethodsEpidemiological surveys were conducted among SARI adult (≥15 years old) cases registered by sentinel surveillance sites in 10 provinces from December 2009 to June 2014, and their respiratory specimen were collected for influenza virus nucleic acid test. All enrolled cases were divided into two groups of hospitalized severe cases and mild cases, and the demographic, clinical, and epidemiological characteristics were compared. In addition, risk factors of severe illness were analyzed. ResultsAmong 3071 SARI patients registered by surveillance sites in 10 provinces from December, 2009 to June, 2014, the median age was 58 years, and 39.69% were over 65-year-old. 2639 (85.93%) had mild illnesses, 432 (14.07%) patients were severe cases. Male, patients over 65-year-old, pregnant women and patients with chronic medical conditions were more susceptible to severe SARI. Fever (96.44%) and cough (85.47%) were two most prevalent clinical symptoms. One third cases had complication. 5.95% SARI patients used antiviral drugs after onset. 240(7.82%) were influenza cases, and most of them were A(H1N1)pdm and A(H3N2) subtypes. Logistic regression suggested that male, chronic medical conditions and delay over 7 days from onset to hospital admission were the risk factors for severe illness; pneumonia was the risk factor for death. ConclusionsSARI cases are mainly male and ≥65 years old. The usage of antiviral drugs are limited in the influenza cases. We recommend hospitalized influenza patients should use antiviral drugs as soon as possible. The main pathogens causing SARI are not known, we recommend respiratory pathogens should be tested.

Key words： Severe acute respiratory infection influenza hospitalized patients adult Risk factor

引用本文:

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. 10省市严重急性呼吸道感染成人住院病例临床特征及重症危险因素分析[J]. 实用预防医学, 2016, 23(1): 25-30. JIANG Hui, YU De-shan, RUAN Feng, XU Wen, HUANG Ting, LI Ling, WANG Kai-li, LIU She-lan, ZHANG Heng-jiao, JIA Ping-dong, YANG Peng, PENG Zhi-bin, ZHENG Jian-dong, FENG Lu-zhao, YU Hong-jie. Clinical characteristics of hospitalized severe acute respiratory illnesses in adults and risk factors of severe illness: results of sentinel surveillance in 10 provinces, China. , 2016, 23(1): 25-30.

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