血液病患者合并甲型流感的临床分析

发布时间：2018-01-14 20:11

本文关键词：血液病患者合并甲型流感的临床分析　出处：《浙江大学》2014年博士论文　论文类型：学位论文

【摘要】：目的：探讨我院住院治疗期间的血液病患者感染甲型流感(包括季节性A(H3N2), A(H1N1)pdm09、A(H7N9))病毒所致呼吸道感染的临床特点,以指导临床诊疗。方法：回顾性分析2013年12月至2014年3月期间我院收治的血液病患者感染甲型流感病毒(包括季节性A(H3N2)、A(HlNl)pdm09、A(H7N9))后所致的呼吸道感染的临床表现、实验室检查、影像学改变、治疗及结局,分析不同流感的临床特点,讨论血液病患者感染甲型流感时的死亡相关的危险因素。结果：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,男女之比为3：1,中位年龄分别为55(25～65)、54(26～79)、58(57～59)岁,基础血液病主要为血液系统肿瘤,H3N2和H1N1患者中院内起病多于院外起病,而2例H7N9均为院外起病。发热(尤其高热)、咳嗽是3种流感亚型主要的临床表现。起病时实验室结果多表现为：淋巴细胞减少、血小板减少、CRP水平明显升高；H3N2患者病程中发现血培养阳性者2例,1例为铜绿假单胞菌,1例为大肠埃希菌；H1N1患者中血培养阳性者1例,为少动鞘氨醇单胞菌；H7N9患者中1例血培养为肺炎克雷伯菌。三种流感亚型的影像学主要表现为两肺多发斑片状高密度影。A(H3N2)、A(H1N1)、A(H7N9)分别在中位起病7.5天(3～33)、5.0天(1～20)、7.5天(7～8)确诊,确诊后即予飞沫隔离,并给予奥司他韦标准剂量抗病毒治疗,重症患者则联用糖皮质激素或丙种球蛋白。H3N2组及HIN1组的病死率分别为25.0%(2/8)、11.5%(3/26),两者之间不存在统计学差异；H7N9组的两例患者均死亡。单因素分析表明：感染H7N9、血液病复发再治疗、继发二重感染尤其是菌血症、血小板减少、CRP增高与患者的死亡相关。多因素分析表明：CRP升高是血液病感染甲型流感时死亡的独立危险因素。结论：1.血液病患者合并A(HlN1)pdm09流感及A(H3N2)流感的临床特征无明显统计学差异。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禽流感则具有高致死性,在血液科临床实践中需给予重视,尤其流感流行季节,对有发热、咳嗽的病人,要加强甲型流感的筛查,尽早诊断、及时治疗。3.单因素分析表明,对于合并甲型流感的血液病患者来说,感染人H7N9流感、血液病复发再治疗、继发二重感染尤其是菌血症、血小板减少、CRP增高与患者的死亡相关。4.多因素分析表明：CRP升高是血液病感染甲型流感时死亡的独立危险因素,CRP水平越高,死亡的风险可能越大。
[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.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R55;R511.7

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