新型甲型H1N1流感重症患者合并ARDS的危险因素分析

Risk factors of novel severe influenza A （ H1N1 ） with concurrent adult respiratory distress syndrome

目的 分析新型甲型H1N1流感重症患者合并急性呼吸窘迫综合征（ARDS）的危险因素.方法 回顾性分析2009年10月至2010年1月中国医科大学附属第一医院收治的92例重症患者的临床特征,比较ARDS组和非ARDS组之间临床特征以及ARDS患者吸烟组和非吸烟组之间淋巴细胞计数和T细胞亚群,采用多变量Logistic回归分析确定患者合并ARDS的危险因素.结果 单因素分析中,吸烟、T细胞亚群、乳酸脱氢酶（LDH）、奥司他韦初始治疗时间、住院时间、病毒转阴时间和初始吸氧流速是否〉2L/min在ARDS组和非ARDS组之间比较差异均有统计学意义（吸烟：17例比11例;初始吸氧流速〉2 L/min：28例比18例;均P〈0.05）;ARDS患者T细胞亚群在吸烟组和非吸烟组之间比较差异均有统计学意义（均P〈0.05）.多变量Logistic回归分析显示吸烟（P=0.027,OR=8.05,95%可信区间：1.28～50.80）和初始吸氧流速〉2L/min（P=0.010,OR=16.70,95%可信区间：3.29～84.84）与ARDS发病相关.结论 吸烟和初始吸氧流速〉2L/min是新型甲型H1N1流感重症患者合并ARDS的危险因素.

Objective To analyze the risk factors of novel severe influenza A （H1N1） with concurrent adult respiratory distress syndrome （ARDS）.Methods A multivariable Logistic regression analysis was conducted for ARDS risk factors in controlled clinical trials for comparing the clinical features between the ARDS and non-ARDS groups and comparing ARDS patients＇ lymphocyte counts and T lymphocyte subsets between the smoking and non-smoking groups through a retrospective analysis of 92 novel influenza A （H1N1） patients who admitted to our hospital from October 2009 to January 2010.Results Through a single factor analysis between ARDS and non-ARDS groups,the comparisons in the factors including smoking（17 cases vs 11 cases）,T lymphocyte subsets,lactate dehydrogenase （LDH）,initial treatment point of oseltamivir and initial oxygen flow greater than 2 L/min （28 cases vs 18 cases） had statistically significant differences （all P 〈 0.05）.The comparison in T lymphocyte subsets had statistically significant difference between the smoking and non-smoking groups in ARDS patients （all P 〈 0.05）.The multivariable Logistic regression analysis showed that smoking （P=0.027,OR=8.05,95% CI：1.28-50.80） and initial oxygen flow greater than 2 L/min （P =0.010,OR=16.70,95%CI：3.29-84.84）were relevant to the incidence of ARDS in novel influenza A （H1N1） patients.Conclusion Smoking and initial oxygen flow greater than 2 L/min were the risk factors of novel severe influenza A （H1N1） with concurrent ARDS.