甲型流感合并细菌陛社区获得性肺炎患者的临床分析

Cfinical analysis on patients with bacterial community-acquired pneumonia and influenza A coinfection

目的探讨甲型流感合并细菌性社区获得性肺炎（CAP）患者的临床特征和结局。方法收集2014--2015年北京、青岛及昆明三地4家医院收治的细菌性CAP以及甲型流感合并细菌性CAP的患者，分为单纯细菌组（137例）和重叠感染组（84例）。对比两组间病原构成、临床特征、治疗方法及预后差异。结果两组患者细菌感染类型均以肺炎链球菌及流感嗜血杆菌为主，差异无统计学意义（P均〉0．05）。重叠感染组外周血淋巴细胞、白蛋白、氧合指数分别为（0．7±0．5）×10^9/L、（27．7±6．0）g／L和（290．9±124．6）mmHg（1mmHg=0．133kPa），均低于单纯细菌组（t=9．752、7．690和5．237，P均〈0．01）；CURB-65评分、PSI分级、血尿素氮、血肌酸激酶、喘息、意识障碍、多叶段浸润分别为（1．5±0．8）分、（3．9±1．1）分、（8．3±5．3）mmol／L、（287．1±25．1）U/L、77．4％、19．0％和76．2％，均高于单纯细菌组（t=-6．227、-14．704、-4．554、-2．042，1；=39．968、14．357、7．264，P均〈0．01）；临床治疗使用机械通气和血管活性药物比例高于单纯细菌组（yz=90．260，49．513，P〈0．01）；且更易发生多脏器衰竭／损伤和脓毒性休克（P均〈0．01），入住ICU和30d病死率显著高于单纯细菌组（X^2=86．074，49．404，P〈0．01）。结论细菌性CAP合并甲型流感病毒感染时将会加重患者的病情，预后更差。

Objective To explore the clinical characteristics and outcomes of patients with bacterial community-acquired pneumonia （CAP） and influenza A coinfection. Methods Data of 137 patients with bacterial CAP （bacterial infection group） and 84 patients with influenza A and bacterial CAP coinfection （coinfection group） were reviewed from four hospitals in Beijing, Qingdao and Kunming during 2014-2015. The pathogenic composition, clinical characteristics, treatments and outcomes of the two groups were compared. Results The main bacterial infections in both groups were Streptococcus pneumoniae and Haemophilus influenzae, with no statistical significances （P both 〉0.05）. In coinfection group, the levels of peripheral blood lymphocyte, albumin and oxygenation index were （0.7±0.5）×10^9/L, （27.7±6.0） g/L and （290.9±124.6） mmHg（1 mmHg = 0.133 kPa）, which were all significantly lower than those in bacterial infection group （t=9.752,7.690 and 5.237, P all〈0.01 ）. CURB-65 score, PSI risk class, blood urea nitrogen, creatine kinase, wheeze, confusion, muhilobar infiltrate were （1.5±0.8） scores, （3.9±1.1） scores, （8.3±5.3） mmol/L, （287.1±25.1） U/L,77.4% 19.0% and 76.2%, were all significantly higher than those in bacterial infection group （t=-6.227, -14.704, -4.554, -2.042, X%39.968,14.357, 7.264, P all〈 0.01）. Mechanical ventilation and vasoactive agents were more often used in coinfection group than in bacterial infection group 0（2=90.260 and 49.513, P〈0.01 ）, while multiple organ failure/damage and septic shock were more likely to occur （P all〈0.01 ）. ICU admission and 30-day mortality were higher in eoinfection group than in bacterial infeetion group（x2=86.074 and 49.404, P〈0.01 ）. Conclusions Bacterial CAP patients co-infected with influenza A virus can exacerbate the disease and have a poorer prognosis.