老年流感及流感样患者临床特征分析

Clinical characteristics analysis of influenza patients and inflenza-like patients in the elderly

目的研究流感流行季节老年流感及流感样患者的临床特征,为老年流感预防治疗提供依据。方法收集2013年1月以流感样症状就诊年龄≥60岁的老年患者临床资料,包括流行病学特点、存在的基础疾病、临床症状、实验室检查结果等,同时留取患者的鼻咽拭子进行流感抗原快速检测(胶体金法);两周后电话随访患者的预后及并发症。结果共收集老年发热患者76例,其中老年流感患者27例,流感样老年患者49例,老年流感患者中单纯甲型流感患者14例,甲型和乙型混合感染13例;流感患者中发生全身酸痛占70.4%高于流感样患者42.9%,差异有统计学意义(P<0.05);发热持续时间流感患者为(2.33±1.27)d、流感样患者为(3.49±2.86)d,差异有统计学意义(P<0.05);在C-反应蛋白增高的患者中,老年流感患者为(51.2±26.2)mg/L、流感样患者为(32.8±32.6)mg/L,差异有统计学意义(P<0.05);27例老年流感患者均痊愈,14例单纯甲型流感患者7例出现合并症,13例甲乙型流感混合感染患者均存在合并症。结论在流感流行季节,老年流感患者可发生甲型和乙型流感的混合感染,同时还并发细菌感染,从而对老年患者的临床症状和治疗产生影响,及时、准确的诊断和治疗,可减少危重症和死亡的发生。

OBJECTIVE To study the clinical features of the elderly influenza patients and the influenza-like patients in seasons of pandemic influenza, so as to provide reference for prevention and treatment of influenza patients in the elderly. METHODS The clinical data of influenza-like patients over 60 years old admitted to hospital in Jan. 2013 were collected, the data included epidemilology features,underlying disease, clinical symptomes, laboratory examination results and so on. Meanwhile the nasopharyngeal swabs from patients were examined in a rapid antigen test （colloidal gold method）. After 2 weeks, the prognosis and complication of the patients were followed up. RESULTS Among 76 cases of elderly patients in fever, 27 patients were in influenza and 49 were influenza-like patients. Among the influenza patients, 14 patients infected only by influenza A virus and 13 patients co-infected with both influenza A and B viruses. The proportion of emerging muscular stiffness in influenza patients was higher than that in influenza-like patients and the difference were significant （70.4% vs 42.9 % P〈0.05）. There was significant difference between patients in two groups for duration of fever, influenza patients （2.33 ± 1.27）d and influenza-like patients （3.49 ± 2.86）d, （P〈0. 05）. In the patients with C reactive protein improvement, influenza patients were （51.2 -4- 26. 2） mg/L, and influenza-like patients were （32. 8 ± 32. 6） mg/L, and the difference was significant （P〈0.05）. All 27 influenza patients were recovered, but there were 7 patients infected only by influenza A virus presenting complication and all 13 patients co-infected with both influenza A and B viruses presented complications. CONCLUSION In flu season, the elderly patients could be co-infected by both influenza A and B viruses and complicating with bacterium infection. These could have an effect on their clinical symptoms and treatment. Timely and accurate diagnosis and treatment could decrease severe case and death in the elderly patients.