神经氨酸酶抑制剂治疗对人感染 H7N9 禽流感住院患者的获益。

Benefit of Early Initiation of Neuraminidase Inhibitor Treatment to Hospitalized Patients With Avian Influenza A(H7N9) Virus.

机构信息

State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University.

Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province.

出版信息

Clin Infect Dis. 2018 Mar 19;66(7):1054-1060. doi: 10.1093/cid/cix930.

DOI:10.1093/cid/cix930

PMID:29077848

Abstract

BACKGROUND

The significance of early neuraminidase inhibitor (NAI) therapy for treating influenza A(H7N9) is currently unknown.

METHODS

The duration of viral shedding was monitored by reverse-transcription polymerase chain reaction after patients with confirmed H7N9 infection were admitted to the First Affiliated Hospital, Zhejiang University, during April 2013-April 2017. Indices such as the length of hospitalization and mortality were collected, and the correlation between the time of administration of NAI and the severity of disease was systematically analyzed.

RESULTS

One hundred sixty patients with confirmed H7N9 infection were divided into 3 groups according to NAI starting time. Three of 20 (15%) patients for whom NAI was administered within 2 days died compared with 12 of 52 (23.1%) patients who received treatment within 2-5 days and 33 of 88 (37.5%) patients who were treated after 5 days (P < .05). The median durations of viral shedding from NAI therapy initiation was 4.5 days (interquartile range [IQR], 3-9 days) for patients who took antiviral medication within 2 days, which was significantly different from that for patients who took medication within 2-5 days (7.5 days [IQR, 4.25-12.75 days]) or after 5 days (7 days [IQR, 5-10 days]) (P < .05). We found that the duration of viral shedding from NAI therapy was the shortest in spring 2013 (5.5 days) and the longest in winter-spring 2016-2017 (8.5 days) (P < .05), showing a prolonged trend.

CONCLUSIONS

Early NAI therapy within 2 days of illness shortened the duration of viral shedding and improved survival in patients with H7N9 viral infection.

摘要

背景

目前尚不清楚早期神经氨酸酶抑制剂（NAI）治疗甲型 H7N9 流感的意义。

方法

2013 年 4 月至 2017 年 4 月，浙江大学第一附属医院收治确诊 H7N9 感染患者后，通过逆转录聚合酶链反应监测病毒脱落持续时间。收集住院时间和死亡率等指标，系统分析 NAI 给药时间与疾病严重程度的关系。

结果

根据 NAI 开始时间将 160 例确诊 H7N9 感染患者分为 3 组。2 天内给予 NAI 的 20 例患者中有 3 例（15%）死亡，2-5 天内接受治疗的 52 例患者中有 12 例（23.1%）死亡，5 天后接受治疗的 88 例患者中有 33 例（37.5%）死亡（P <.05）。2 天内开始抗病毒治疗的患者，从开始 NAI 治疗到病毒脱落的中位时间为 4.5 天（四分位距 [IQR]，3-9 天），与 2-5 天内开始治疗的患者（7.5 天 [IQR，4.25-12.75 天]）和 5 天后开始治疗的患者（7 天 [IQR，5-10 天]）明显不同（P <.05）。我们发现，2013 年春季（5.5 天）NAI 治疗后病毒脱落时间最短，2016-2017 年冬春季（8.5 天）最长（P <.05），呈延长趋势。