武汉市某医院2016-2017年流行性感冒流行病学与临床特征分析

Epidemiological and Clinical Characteristics of Inpatients with Influenza in a Hospital in Wuhan During 2016-2017

目的：分析武汉市某医院2016-2017年流行性感冒发病情况及临床特征,为流感的防治提供科学数据依据。方法：选取2016年3月至2017年4月武汉大学中南医院儿科住院并隔离治疗的766例流感患儿,回顾病历资料,分析其人口学、流行病学、临床表现和实验室检查特征,并作统计分析。结果：收治的766例流感病人中乙型流感（乙流）为50.1%,甲型流感（甲流）19.3%、同时感染甲流乙流30.6%,主要集中在1-8岁年龄段,8-14岁年龄段最少,0-1岁次之,8岁以下儿童的流感有随年龄增加而上升的趋势,男性与女性无统计学差异（P=0.133）;甲流、乙流、甲乙混合型流感全年均有发生,在13个月中共有4个流感高峰期,主要集中于冬季和春季。分别在2016年的3-4月份、2016年的8月份、2016年的11-12月份、2017年的3-4月份。流感高峰期的流感病毒亚型略有不同,在前三个峰中以乙流病毒为主,第四个峰以甲型乙型混合流行,乙流占优势,2017年3-4月的流行强度明显高于2016年3-4月。甲流春季和夏季比乙流早1个月出现,上述差异均有统计学意义（P=0.000）;甲流病例中发热、咳嗽、头痛、呕吐明显高于乙流和甲乙混合型流感,有统计学意义（P〈0.05）,且肺炎和心肌损伤的并发症也高于乙流和甲乙混合型流感;经实验室检查甲流的外周白细胞总数、中性粒细胞百分数、PCT、C反应蛋白均高于乙流和甲乙混合型流感,有统计学意义（P=0.009;0.04;0.00）;从疾病史上看,患过湿疹、早产以及1个月内有呼吸系统疾病的儿童更易感染甲流（P=0.00;0.001;0.005）。结论：武汉市流感呈现季节峰;乙流为主;甲流春季和夏季比乙流早1个月出现;甲流患儿临床症状比乙流和甲乙混合型严重。

Objective：To analyze the prevalence and clinical characteristics of influenza in a hospital in Wuhan during 2016-2017 for providing data to support influenza prevention and treatment.Methods：A total of 766 pediatric patients with influenza admitted,isolated,and treated in the Department of Pediatrics,Zhongnan Hospital of Wuhan University from March 2016 to April2017 were included in this study.Their medical records were reviewed,and demographics,epidemiology,clinical manifestations,and laboratory results were analyzed.Results：Among the 766 cases,50.1% were influenza B virus（FluB）;19.3% were influenza A virus（FluA）;and 30.6%were FluB combined with FluA.Influenza presented most commonly at 1-8 years of age and least commonly at the 8-14 age.The prevalence of influenza increased with age in the population under age of 8,with no significant difference between genders（P=0.133）.FluA,FluB and mixed FluAB occurred year round,but with peak seasons during March/April（both in 2016 and2017）,August,and November/December.FluB was the dominant virus in the first three peaks,and FluAB coinfection dominated the greater-intensity March/April 2017 peak.The incidence of FluA in spring and summer occurred a month earlier than the incidence of FluB.Symptoms of fever,cough,headache,and vomiting in FluA cases were more frequent than in FluB or FluAB co-infection cases（P=0.000）.Pneumonia and myocardial injury in FluA were more prevalent than in mixed FluAB.Total white blood cells,procalcitonin,C-reactive protein in blood samples of FluA patients were significantly higher than those in the FluB or the mixed FluAB patients（P=0.009;0.04;0.00,respectively）.Children with histories of eczema,premature birth,and respiratory disease（s）within a month were more susceptible to FluA than others without such medical histories（P=0.00;0.001;0.005,respectively）.Conclusion：Seasonal peaks of pediatric influenza were found in Wuhan City.FluB dominated in prevalence but often lagged behind FluA by one month.FluA symptoms were more severe than mixed FluAB.