北京市2009年甲型H1N1流行性感冒危重症与死亡病例流行病学特征及其影响因素分析

Analysis of epidemiological features and risk factors of severe cases and deaths of pandemic influenza A （H1N1） 2009 in Beijing

目的 了解北京市2009年甲型H1N1流行性感冒（流感）危重症与死亡病例的流行病学特征,探讨影响甲型H1N1流感病情严重程度的主要因素.方法 利用北京市2009年甲型H1N1流感病例个案信息进行描述性分析和多因素Logistic回归分析.结果 北京市2009年甲型H1N1流感感染率为66.1/10万,25～60岁组人群感染率最高,为86.8/10万.0～5岁组和60岁以上年龄组危重症感染率（12.5/10万,3.9/10万）、死亡率（0.9/10万,0.7/10万）和病死率（2.4%,3.3%）较高.549例危重症病例中学龄前儿童110例,比例最高,占20.0%,69例死亡病例中离、退休人员17例,比例最高,占24.6%.超过70.0%的危重症和死亡病例均在发病后2 d内到医院就诊.危重症病例和死亡病例中,均以有心血管疾病的病例比例最高,其次为慢性肺部疾病.多因素Logistic回归分析显示,甲型H1N1流感病例中,60岁以上、慢性肺部疾病及心血管疾病可能导致其病情较重,OR值分别为3.586（95%CI 1.586～8.117）、2.126（95%CI 1.178～3.835）和1.954（95%CI 1.126～3.391）.结论 60岁以上、伴心血管疾病及慢性肺部疾病等因素可能加重甲型H1N1流感病例病情.

Objective To describe the epidemiological features of severe cases and deaths of pandemic influenza A （H1N1） 2009 in Beijing and to explore the main risk factors associated with the disease severity. Methods Data of pandemic influenza A （H1N1） 2009 reported in Beijing were collected and analyzed. The relative risks between disease condition and possible risk factors were determined using the multi-factor Logistic regression analysis. Results The incidence of pandemic influenza A（H1N1） 2009 was 66. 1/100 000, and the highest incidence was 86. 8/100 000 which occurred among people aged 25-60 years old. The prevalence of critical patients （12. 5/100 000 and 3.9/100 000, respectively）, mortality （0. 9/100 000 and 0. 7/100 000, respectively） and fatality （2.4 % and 3.3 %, respectively） in people aged 0-5 years old and above 60 years old were higher than other age groups. There were 110 （20. 0%） preschool children among 549 critical cases, which were the largest proportion of critical cases. Among 69 death cases, 17 （24. 6%） were retirees with the highest proportion of death cases. More than 70. 0% of the critical cases and deaths visited hospital within two days of onset. The chronic heart disease and chronic lung disease were the most frequent risk factors of severe and death cases. Multi-factor Logistic regression analysis showed that the variables including aged above 60 years old （OR = 3. 586, 95 % CI = 1. 586 - 8. 117）, chronic heart disease （OR=2. 126, 95%CI= 1. 178-3. 835）, and chronic lung disease （OR=1. 954, 95%CI=1. 126-3. 391） were significantly associated with the disease severity. Conclusion Factors of aged above 60 years older, chronic heart disease and chronic lung disease may aggravate the severity of influenza A （H1N1）.