人感染H7N9禽流行性感冒的中西医结合治疗及预后分析

Prognosis and efficacy of integrative treatment for novel H7N9 avian influenza virus infection in human

目的分析新型人感染H7N9禽流行性感冒的临床特点以及结合中药治疗的预后。方法2013年4月5日至2013年4月19日上海市公共卫生临床中心收治的H7N9禽流行性感冒患者18例。根据病情严重程度分为轻症组8例和重症组10例。在抗病毒、抗感染、激素和人免疫球蛋白治疗的同时，轻症组予以银翘散合升降散加减治疗，重症组予以清瘟败毒饮或宣白承气汤加减治疗。分析两组基线情况，评价预后，并探讨预后相关因素。正态分布资料采用t检验，非正态分布资料采用秩和检验，分类变量采用7。检验和Fisher确切概率法，影响因素采用单因素和多因素Logistic回归分析。结果基线水平，重症组C反应蛋白为（102．61±30．80）mg／L，明显高于轻症组患者的（38．44±22．31）mg／L（t=4．717，P％0．01）。重症组CD3＋、CD4＋、CD8＋和CD45＋T淋巴细胞水平明显降低（均P〈0．05）。与含激素和人免疫球蛋白治疗相比，含中药的治疗方案可获得较高的康复率（12／14）。单因素Logistic回归分析结果显示，肌红蛋白为影响H7N9禽流行性感冒患者预后的危险因素（P=0．029）。多因素Logistic回归分析结果显示，肌红蛋白的升高可能为影响HTN9禽流行性感冒患者预后的危险因素（P=0．053）。结论重症H7N9禽流行性感冒患者炎性活动明显，细胞免疫功能低下。中西医结合治疗人感染H7N9禽流行性感冒患者疗效确切，可一定程度改善患者预后。

Objective This study aimed to analyze the clinical features of novel H7N9 avian influenza virus infection in human and its prognosis after integrative treatment. Methods Eighteen HTN9 infected patients were admitted to Shanghai Public Health Clinical Center from 5 April 2013 to 19 April 2013, and were divided into mild group （8 cases） and severe group （10 cases） based on their baseline disease conditions. Patients in mild group were administered modified Yinqiao powder and Shengjiang powder, while patients in severe group were administered modified Qinwen Baidu Decoction or Xuanbai Chengqi Decoction, in addition to antiviral, anti infection, glucocorticoids and human immunoglobulin treatment in both groups. Baseline characteristics and outcomes of these patients were analyzed, and factors associated with prognosis were also evaluated. Measurement data were compared by t test or rank sum test, categorical variables were compared by chi-square test or Fisher exact test. Factors associated with prognosis were evaluated by Logistic regression analysis. Results Compared to mild group, patients in severe group suffered from a significantly elevated C-reactive protein [（102.61± 30. 80） mg/L vs （38.44± 22.31） rag/L; t=4. 717, P〈0.01], and significantly lowered CD3＋, CD4＋ , CD8＋ and CD45＋ T cell levels （all P〈0. 05）. Compared to regimens with glucocorticoids and human immunoglobulin, traditional Chinese medicine （TCM） contained therapy achieved a higher recovery rate in H7N9 infected patients, but with no statistical significance （P〉0.05）. Univariate Logistic regression analysis showed that myoglobin might be a risk factor associated with prognosis of H7N9 infection （P= 0. 029）, and multivariable analysis showed that high levels of myoglobin might be negatively related to the prognosis of H7N9-infected patients, but with no statistical significance （P= 0. 053）. Conclusions Severe H7N9 infected patients suffer from active inflammation and lowered T cell-mediated immune response. Integrative therapy is effective for novel H7N9 avian influenza virus infection, and helps to improve the outcomes of infected patients.