流感患者的流行病学特点及临床特征研究

Epidem iological and clinical features of influenza patients

目的探讨流感患者的流行病学特点及临床特征。方法采集2014—2015年杭州市第一人民医院发热门诊的2 083例流感样症状患者的咽拭子样本,并送杭州市疾病预防控制中心进行检测。采用real-time RT-PCR法对流感病毒进行检测与基因分型,收集流感病毒检测阳性患者的临床资料、实验室检查结果、影像学检查结果和不同治疗结果等,根据不同年龄段进行回顾性分析。结果流感病毒检测阳性493例,阳性率为23.67%,其中B型流感、H3N2流感和H1N1流感分别为163、256和74例。全年以1~2月、7~8月为流感病毒检测阳性高峰。85.60%的患者无明显流行病学接触史,主要临床表现有发热（100.00%）、咳嗽（82.76%）、咽痛（80.12%）、全身酸痛（47.86%）、咽部充血（93.30%）和扁桃体肿大（38.94%）等。≥60岁组有基础疾病史、接受住院治疗的比例均明显高于14岁~、25岁~组（均P〈0.01）,14岁~组扁桃体肿大发生率明显高于≥60岁、25岁~组（均P〈0.01）。大部分患者血WBC（79.92%）和C反应蛋白（CRP,84.79%）水平正常;5.79%的患者ALT水平异常升高;4.17%的患者肌酸激酶（CK）异常升高;10.17%的患者合并肺部影像学异常。≥60岁组患者CRP异常升高、影像学异常发生率均明显高于其他年龄组（均P〈0.01）。流感患者治愈率为99.60%,≥60组患者体温恢复正常时间、症状完全恢复时间均明显较长（均P〈0.01）。与未抗病毒治疗组比较,奥司他韦抗病毒治疗组、特效感冒方中药治疗组患者体温恢复正常、症状完全恢复时间均明显缩短（均P〈0.05）。结论流感在发热门诊流感样症状患者中检出率较高,但临床症状较轻,总体预后较好,但应重视老年患者。奥司他韦、本院特效感冒方中药治疗均可明显缩短病程,促进疾病恢复。

Objective To analyze the epidemiological and clinical characteristics of influenza patients. M ethods Oropharyngeal swabs were collected from 2083 influenza-like illness patients visiting Fever Clinic of Hangzhou First People＇s Hospital During January 2014 to December 2015. Real time fluorescence quantitative Polymerase chain reaction assay was used to identify the viral pathogens and their genotypes. The epidemiological information, clinical characteristics, laboratory findings and the treatment results of patients were analyzed. Results Influenza viruses were positive in 493 cases with a positive rate of23.67%, including 163 cases of influenza B, 256 cases of influenza H3N2 and 74 cases influenza H1N1. The highest positive rate was found in January-February, July-August, and 85.60% patients had no definitely history of epidemiological exposure. The main symptoms and physical signs were fever（100.00%）, cough（82.76%）, pharyngalgia（80.12%）, body aches（47.86%）, throat congestion（93.30%） and swelling of tonsil（38.94%）. Patients aged ≥60 years had more underlying diseases and hospitalization rates than those in age groups 14～and 25～ years（P〈0.01）. Patients in age group 14～years had more swelling of tonsil than the other two age groups（P〈0.01）. The white cell count and serum CRP levels were normal in most patients（79.92% and84.79%, respectively）, 5.79% patients had increased levels of ALT, 4.17% had increased levels of CK, and 10.17% patients had abnormal chest X-ray findings. Patients aged ≥60 years had more CRP increase and chest X-ray abnormalities than other two age groups（P 〈0.01）.The cure rate of influenza patients was 99.60% in this study. The duration of fever and the symptom disappearance time in age group ≥60 years were significantly prolonged（P 〈0.01）. The duration of fever and symptom disappearance time in patients receiving oseltamivir or traditional Chinese medicine treatment were significantly shorter than those without antiviral treatment（P〈0.05）. Conclusion The symptoms of influenza are generally mild and the overall prognosis is good; but attention should be paid for elderly patients. Oseltamivir and traditional Chinese medicine treatment may shorten thecourse and promote the disease recovery.