上海西区哨点医院16岁以上人群FluA病例临床特征分析

Analysis of clinical characteristics of FluA patients aged 16 years or over in the West Point sentinel hospital in Shanghai

目的流感样病例(influenza-like illness,ILI)是指发热,伴咳嗽或咽痛之一者,同时缺乏其他实验室诊断依据。本研究探讨上海市西区哨点医院≥16岁ILI中甲型流感病毒(influenza A virus,FluA)病例的临床流行特征,以指导临床医生降低对ILI抗生素的使用。方法选择2014-05-03-2016-04-30上海市西区哨点医院收治的2 028例ILI患者作为研究对象,采集其鼻咽拭子,应用实时荧光定量RT-PCR方法和套式多重反转录聚合酶链反应,检测FluA、乙型流感病毒(influenza B virus,FluB)、副流感病毒(parainfluenza virus,PIV)、呼吸道合胞病毒(respiratory syncytial virus,RSV)、腺病毒(adenovirus,ADV)、微小核糖核酸病毒(picornaviruses,PicoRNA)、人偏肺病毒(human metapneumovirus,hMPV)、冠状病毒(coronavirus,CoV)和人博卡病毒(human bocavirus,HBoV),分析ILI病例中FluA病例的临床特点。结果 9种呼吸道病毒检测阳性率达28.30%(574/2 028),其中FluA阳性249例(12.30%),FluB阳性87例(4.30%),Para Flu阳性20例(1.00%),PicoRNA阳性34例(1.70%),ADV阳性62例(3.10%),RSV阳性83例(4.10%),CoV阳性5例(0.20%),hMPV阳性7例(0.30%),HBoV阳性3例(0.15%);24份标本(1.18%)为2种病毒重叠感染,RSV的重叠感染率最高,有19例(0.94%),未见3种病毒重叠感染;FluA阳性检出率构成比最高,为43.38%;体温(t=2.738,P=0.006)、乏力(χ~2=23.730,P<0.001)、白细胞计数(t=3.457,P=0.001)和中性粒细胞分类(χ~2=23.950,P<0.001)等临床特征对FluA病例有影响。结论 FluA在ILI哨点医院中检出率占比最高,且体温、乏力、白细胞计数和中性粒细胞分类等临床特征在FluA病例中比较明显。

OBJECTIVE Influenza-like illness(ILI)refers to fever,with cough or sore throat,and lack of other laboratory diagnostic basis.This study aims to explore the clinical prevalence of influenza A virus(FluA)in ILI over 16 years old in the sentinel Hospital of West District of Shanghai,to guide the clinicians to reduce the use of ILI antibiotics.METHODS A total of 2 028 cases of ILI patients in the West sentinel Hospital in Shanghai from May 3,2014 to April 30,2016 were selected as the subjects,and their nasopharyngeal swabs were collected.The real-time fluorescence quantitative RT-PCR method and the nested multiplex reverse transcription polymerase chain reaction were used to detect FluA,influenza B virus(FluB),parainfluenza virus(PIV),respiratory syncytial virus(RSV),adenovirus(ADV),picornaviruses(PicoRNA),human metapneumovirus(hMPV),coronavirus(CoV)and human bocavirus(HBoV).The clinical features of FluA cases in ILI cases were analyzed.RESULTS The positive rate of 9 kinds of respiratory viruses was 28.30%(574/2 028),including 249(12.30%)of FluA positive,87(4.30%)of FluB positive,20(1.00%)of Para Flu positive,and34 cases of PicoRNA positive(1.70%),ADV positive in 62 cases(3.10%),RSV positive in 83 cases(4.10%),CoV positive in 5 cases(0.20%),hMPV positive in 7 cases(0.30%),HBoV positive in 3 cases(0.15%).24 specimens(1.18%)were overlapped by two viruses,and the overlapping infection rate of RSV was the highest,with 19(0.94%),no overlap of three viruses.The ratio of positive detection rate of FluA was the highest,which was 43.38%.The clinical features such as body temperature(t=2.738,P=0.006),asthenia(χ~2=23.730,P<0.001),leukocyte count(t=3.457,P=0.001)and neutrophil(χ~2=23.950,P<0.001)had influence on the cases of FluA.CONCLUSIONS FluA has the highest detection rates in ILI in sentinel hospitals.The clinical characteristics of body temperature,fatigue,white blood cell count and neutrophil classification are more obvious in FluA cases.