与甲型流感病毒（H7N9）感染患者病毒持续排出相关的因素。
Factors Associated With Prolonged Viral Shedding in Patients With Avian Influenza A(H7N9) Virus Infection.
机构信息
Xuanwu Hospital of Capital Medical University, Beijing.
Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing.
出版信息
J Infect Dis. 2018 May 5;217(11):1708-1717. doi: 10.1093/infdis/jiy115.
BACKGROUND
Data are limited on the impact of neuraminidase inhibitor (NAI) treatment on avian influenza A(H7N9) virus RNA shedding.
METHODS
In this multicenter, retrospective study, data were collected from adults hospitalized with A(H7N9) infection during 2013-2017 in China. We compared clinical features and A(H7N9) shedding among patients with different NAI doses and combination therapies and evaluated factors associated with A(H7N9) shedding, using Cox proportional hazards regression.
RESULTS
Among 478 patients, the median age was 56 years, 71% were male, and 37% died. The median time from illness onset to NAI treatment initiation was 8 days (interquartile range [IQR], 6-10 days), and the median duration of A(H7N9) RNA detection from onset was 15.5 days (IQR, 12-20 days). A(H7N9) RNA shedding was shorter in survivors than in patients who died (P < .001). Corticosteroid administration (hazard ratio [HR], 0.62 [95% confidence interval {CI}, .50-.77]) and delayed NAI treatment (HR, 0.90 [95% CI, .91-.96]) were independent risk factors for prolonged A(H7N9) shedding. There was no significant difference in A(H7N9) shedding duration between NAI combination treatment and monotherapy (P = .65) or between standard-dose and double-dose oseltamivir treatment (P = .70).
CONCLUSIONS
Corticosteroid therapy and delayed NAI treatment were associated with prolonged A(H7N9) RNA shedding. NAI combination therapy and double-dose oseltamivir treatment were not associated with a reduced A(H7N9) shedding duration as compared to standard-dose oseltamivir.
背景
关于神经氨酸酶抑制剂（NAI）治疗对甲型流感病毒（H7N9）病毒 RNA 脱落的影响的数据有限。
方法
在这项多中心、回顾性研究中，数据来自 2013 年至 2017 年期间在中国因感染甲型流感病毒（H7N9）而住院的成年人。我们比较了不同 NAI 剂量和联合治疗的患者的临床特征和 H7N9 脱落情况，并使用 Cox 比例风险回归评估了与 H7N9 脱落相关的因素。
结果
在 478 例患者中，中位年龄为 56 岁，71%为男性，37%死亡。从发病到开始 NAI 治疗的中位时间为 8 天（四分位距 [IQR]，6-10 天），从发病到甲型流感病毒（H7N9）RNA 检测的中位持续时间为 15.5 天（IQR，12-20 天）。与死亡患者相比，幸存者的 H7N9 RNA 脱落时间更短（P<0.001）。皮质类固醇的使用（风险比 [HR]，0.62 [95%置信区间 {CI}，0.50-0.77]）和 NAI 治疗的延迟（HR，0.90 [95% CI，0.91-0.96]）是甲型流感病毒（H7N9）RNA 脱落时间延长的独立危险因素。NAI 联合治疗与单药治疗（P=0.65）或标准剂量与双倍剂量奥司他韦治疗（P=0.70）之间的 H7N9 脱落时间无显著差异。
结论
皮质类固醇治疗和 NAI 治疗的延迟与甲型流感病毒（H7N9）RNA 脱落时间延长有关。与标准剂量奥司他韦相比，NAI 联合治疗和双倍剂量奥司他韦治疗并未导致甲型流感病毒（H7N9）脱落时间缩短。
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