本文關(guān)鍵詞：血液病患者合并甲型流感的臨床分析　出處：《浙江大學》2014年博士論文　論文類型：學位論文

  更多相關(guān)文章： 血液病患者 季節(jié)性A(H3N2)流感 A(H1N1)pdm09流感 A(H7N9)流感 臨床特征 死亡相關(guān)因素

【摘要】：目的：探討我院住院治療期間的血液病患者感染甲型流感(包括季節(jié)性A(H3N2), A(H1N1)pdm09、A(H7N9))病毒所致呼吸道感染的臨床特點,以指導(dǎo)臨床診療。 方法：回顧性分析2013年12月至2014年3月期間我院收治的血液病患者感染甲型流感病毒(包括季節(jié)性A(H3N2)、A(HlNl)pdm09、A(H7N9))后所致的呼吸道感染的臨床表現(xiàn)、實驗室檢查、影像學改變、治療及結(jié)局,分析不同流感的臨床特點,討論血液病患者感染甲型流感時的死亡相關(guān)的危險因素。 結(jié)果：在本流行季我院收治的血液病患者中,A(H3N2)8例、A(HlN1)pdm09有26例、A(H7N9)有2例,男女之比為3：1,中位年齡分別為55(25～65)、54(26～79)、58(57～59)歲,基礎(chǔ)血液病主要為血液系統(tǒng)腫瘤,H3N2和H1N1患者中院內(nèi)起病多于院外起病,而2例H7N9均為院外起病。發(fā)熱(尤其高熱)、咳嗽是3種流感亞型主要的臨床表現(xiàn)。起病時實驗室結(jié)果多表現(xiàn)為：淋巴細胞減少、血小板減少、CRP水平明顯升高；H3N2患者病程中發(fā)現(xiàn)血培養(yǎng)陽性者2例,1例為銅綠假單胞菌,1例為大腸埃希菌；H1N1患者中血培養(yǎng)陽性者1例,為少動鞘氨醇單胞菌；H7N9患者中1例血培養(yǎng)為肺炎克雷伯菌。三種流感亞型的影像學主要表現(xiàn)為兩肺多發(fā)斑片狀高密度影。A(H3N2)、A(H1N1)、A(H7N9)分別在中位起病7.5天(3～33)、5.0天(1～20)、7.5天(7～8)確診,確診后即予飛沫隔離,并給予奧司他韋標準劑量抗病毒治療,重癥患者則聯(lián)用糖皮質(zhì)激素或丙種球蛋白。H3N2組及HIN1組的病死率分別為25.0%(2/8)、11.5%(3/26),兩者之間不存在統(tǒng)計學差異；H7N9組的兩例患者均死亡。單因素分析表明：感染H7N9、血液病復(fù)發(fā)再治療、繼發(fā)二重感染尤其是菌血癥、血小板減少、CRP增高與患者的死亡相關(guān)。多因素分析表明：CRP升高是血液病感染甲型流感時死亡的獨立危險因素。 結(jié)論：1.血液病患者合并A(HlN1)pdm09流感及A(H3N2)流感的臨床特征無明顯統(tǒng)計學差異。2.在血液病患者中,A(HlN1)pdm09流感及A(H3N2)流感有一定的致死性,而人H7N9禽流感則具有高致死性,在血液科臨床實踐中需給予重視,尤其流感流行季節(jié),對有發(fā)熱、咳嗽的病人,要加強甲型流感的篩查,盡早診斷、及時治療。3.單因素分析表明,對于合并甲型流感的血液病患者來說,感染人H7N9流感、血液病復(fù)發(fā)再治療、繼發(fā)二重感染尤其是菌血癥、血小板減少、CRP增高與患者的死亡相關(guān)。4.多因素分析表明：CRP升高是血液病感染甲型流感時死亡的獨立危險因素,CRP水平越高,死亡的風險可能越大。
[Abstract]:Objective: to explore the infection of influenza A (including seasonal AH3N2P, AHH1N1 / pdm09) in patients with hematologic diseases during hospitalization in our hospital. The clinical features of respiratory tract infection caused by AH7 N 9) virus were used to guide clinical diagnosis and treatment. Methods: from December 2013 to March 2014, patients with hematologic diseases in our hospital were treated with influenza A virus (including seasonal Agna H3N2). The clinical manifestation, laboratory examination, imaging changes, treatment and outcome of respiratory tract infection caused by AHlNlP PDM09) were analyzed and the clinical characteristics of different influenza were analyzed. To discuss the risk factors associated with death from influenza A infection in patients with hematologic diseases. Results: there were 2 cases of AH7N9 in 8 cases of AH1N1Pm09 in our hospital. The ratio of male and female was 3: 1. The ratio between male and female was 3: 1. The ratio of male to female was 3: 1. The ratio of male to female was 3: 1. The ratio of male to female was 3: 1. The ratio of male to female was 3: 1. The median age was 55 ~ 25 / 65, 54 / 2679 / 59), respectively. The primary hematologic diseases were hematological neoplasms. In patients with H3N2 and H1N1, nosocomial onset was more than that outside hospital, while two cases of H7N9 were both nosocomial and febrile (especially high fever). Cough is the main clinical manifestation of three influenza subtypes. The laboratory results are as follows: lymphocytopenia, thrombocytopenia and CRP level increase obviously; Two cases of positive blood culture were found in the course of H3N2. One case was Pseudomonas aeruginosa and one case was Escherichia coli. One patient with positive blood culture in H1N1 was sphingomonas oligostreptoma. One patient with H7N9 was cultured with Klebsiella pneumoniae. The imaging findings of the three influenza subtypes were as follows: multiple lamellar high-density shadows in both lungs. The diagnosis of AH7N9 was made on 7.5 days after median onset of the disease. The severe patients were treated with glucocorticoid or gamma globulin. H3N2 group and HIN1 group had a mortality of 25.0% and 2 / 8 respectively. There was no statistical difference between the two groups. Univariate analysis showed that infection of H7N9, recurrence and retreatment of hematopathy, secondary double infection, especially bacteremia, thrombocytopenia. The increase of CRP was associated with death in patients. Multivariate analysis showed that the increase of CRP was an independent risk factor for the death of patients with influenza A infection with hematologic diseases. Conclusion there is no significant difference in the clinical characteristics of patients with hematologic diseases with AHlN1Pdm09 and AH3N2) flu. 2. In patients with hematologic diseases, there is no significant difference in the clinical characteristics. AHlN1 / pdm09 and AH3N2) influenza have a certain mortality, while human H7N9 avian influenza is highly lethal, which should be paid more attention to in clinical practice in hematology department. Especially in the influenza epidemic season, for patients with fever and cough, screening for influenza A should be strengthened, diagnosis should be made as early as possible, and timely treatment should be made. 3. Univariate analysis shows that for patients with hematological diseases associated with influenza A, it is necessary to do so. Infection with human H7N9 influenza, relapse and retreatment of hematopathy, secondary double infection, especially bacteremia, thrombocytopenia. Multivariate analysis showed that the increase of CRP was the independent risk factor of blood disease infection with influenza A, and the higher the level of CRP was, the higher the risk of death was.
【學位授予單位】：浙江大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R55;R511.7

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