Huang Shi-Yu, Huang Wen-Chi, Chen Yi-Chun, Tsai Ching-Yen, Lee Ing-Kit
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Am J Trop Med Hyg. 2017 Dec;97(6):1945-1951. doi: 10.4269/ajtmh.17-0172. Epub 2017 Sep 21.
We conducted a retrospective study to compare clinical and laboratory findings between 1) severe influenza A and mild influenza A and 2) pandemic 2009 H1N1 (pdm09 A/H1) and seasonal H3N2 (A/H3) from 2009 to 2010. A total of 526 (mean age, 13.6 years; 447 pdm09 A/H1, 79 seasonal A/H3) patients were included, 41 (7.8%) with severe influenza (mean age, 28.1 years; 26 pdm09 A/H1, 15 seasonal A/H3). Influenza-associated complications were pneumonia (75.6%), meningoencephalitis (14.6%), acute kidney injury (14.6%), and acute respiratory distress syndrome (12.2%). Patients with seasonal A/H3 were significantly less likely to experience sore throat ( < 0.001), malaise ( < 0.001), and muscle pain ( < 0.001); they were significantly more likely to have hypertension ( < 0.001), diabetes mellitus ( = 0.001), and chronic obstructive pulmonary disease ( < 0.001), delayed hospital presentation ( = 0.001), delayed oseltamivir treatment ( < 0.001), and higher in-hospital mortality ( = 0.02) than patients with pdm09 A/H1. Further comparison between severe pdm09 A/H1 and severe seasonal A/H3 revealed that severe seasonal A/H3 patients (median age, 71 years) were significantly older than patients with severe pdm09 A/H1 (median age, 7 years) ( < 0.001). Comparison between severe influenza and mild influenza, regardless of influenza A subtypes, by multivariate analysis, found that tachypnea (odds ratio [OR] = 44.3, 95% confidence interval [CI] = 15.7-124.6) and delayed oseltamivir therapy ≧ 48 hours after illness onset (OR = 3.7, 95% CI = 1.3-10.5) were independent risk factors for severe influenza. The findings of this study will improve the understanding of the clinical differences between pdm09 A/H1 and seasonal A/H3, and of influenza-associated complications and predictors for severe outcomes that can help to direct clinicians toward the most effective management of influenza patients to reduce the preventable mortality and morbidity.
我们进行了一项回顾性研究，以比较：1）甲型流感重症与轻症之间以及2）2009年至2010年大流行的2009 H1N1（pdm09 A/H1）与季节性H3N2（A/H3）之间的临床和实验室检查结果。共纳入526例患者（平均年龄13.6岁；447例pdm09 A/H1，79例季节性A/H3），其中41例（7.8%）为重症流感（平均年龄28.1岁；26例pdm09 A/H1，15例季节性A/H3）。流感相关并发症包括肺炎（75.6%）、脑膜脑炎（14.6%）、急性肾损伤（14.6%）和急性呼吸窘迫综合征（12.2%）。季节性A/H3患者出现咽痛（<0.001）、全身不适（<0.001）和肌肉疼痛（<0.001）的可能性显著更低；与pdm09 A/H1患者相比，他们患高血压（<0.001）、糖尿病（=0.001）和慢性阻塞性肺疾病（<0.001）的可能性显著更高，住院延迟（=0.001）、奥司他韦治疗延迟（<0.001）以及院内死亡率更高（=0.02）。重症pdm09 A/H1与重症季节性A/H3之间的进一步比较显示，重症季节性A/H3患者（中位年龄71岁）比重症pdm09 A/H1患者（中位年龄7岁）年龄显著更大（<0.001）。通过多变量分析比较重症流感和轻症流感，无论甲型流感亚型如何，发现呼吸急促（优势比[OR]=44.3，95%置信区间[CI]=15.7-124.6）以及发病后≧48小时奥司他韦治疗延迟（OR=3.7，95%CI=1.3-10.5）是重症流感的独立危险因素。本研究结果将增进对pdm09 A/H1与季节性A/H3之间临床差异、流感相关并发症以及严重结局预测因素的理解，有助于指导临床医生对流感患者进行最有效的管理，以降低可预防的死亡率和发病率。
