成人甲型流感病毒核酸持续时间及其相关影响因素分析

Analysis of nucleic acid duration of influenza A virus in adults and related influencing factors

目的分析成人甲型流感(以下简称甲流)核酸的持续时间及其相关影响因素。方法收集2018年11月至2019年2月于首都医科大学附属北京佑安医院收治的107例咽拭子甲流病毒核酸PCR检测阳性的成人甲流患者临床资料,将其分为单纯甲流组(9例)、甲流\肺炎组(15例)、甲流\基础疾病组(21例)和甲流\肺炎\基础疾病组(62例),对其临床特点、病毒核酸持续时间以及相关影响因素进行回顾性分析。结果前5位基础疾病为高血压(47例,43.9%)、2型糖尿病(27例,25.2%)、冠状动脉粥样硬化性心脏病(26例,24.3%)、脑梗死(13例,12.1%)和慢性阻塞性肺疾病(10例,9.3%)。前5位临床症状为发热(106例,99%)、咳嗽(94例,87.9%)、喘憋(21例,19.6%)、乏力(20例,18.7%)和肌痛(20例,18.7%)。单纯甲流组、甲流/肺炎组、甲流\基础疾病组、甲流\肺炎\基础疾病组的病毒核酸持续时间分别为3.0(1.5,5.0)、6.0(4.0,10.0)、3.0(1.5,6.5)和6.0(3.0,10.0)d,组间差异有统计学意义(P<0.05)。起病48 h内行抗流感病毒治疗的患者,其病毒核酸持续时间和体温恢复正常所需时间均短于48 h以后行抗病毒治疗者,差异有统计学意义(P <0.01)。体温恢复正常的甲流患者中,有54.7%病毒核酸仍呈阳性。结论合并肺炎和起病48 h内未进行抗病毒治疗是甲流病毒核酸持续时间较长的主要因素,部分甲流患者体温正常出院时核酸尚未转阴,应在出院后居家隔离以避免传染他人。

Objective To investigate the duration and influencing factors of viral nucleic acid shedding in adults with influenza A. Methods The clinical data of 107 adults with positive influenza A virus nucleic acid in pharyngeal swab detected by PCR were collected. The adults were divided into simple influenza A group(n = 9), influenza A-pneumonia group(n =15), influenza A-underlying disease group(n = 21), and influenza A-pneumonia-underlying disease group(n = 62). A retrospective analysis was performed for clinical features, treatment process, duration of viral nucleic acid shedding, and prognosis.Results The top five underlying disease were hypertension(n = 47, 43.9%), type 2 diabetes(n = 27, 25.2%), coronary atherosclerotic heart disease(n = 26, 24.3%), cerebral infarction(n = 13, 12.1%) and chronic obstructive lung disease(n = 10,9.3%). The most common symptoms in these adults were fever(n = 106, 99.1%), cough(n = 94, 87.9%), short of breath(n =21, 19.6%), fatigue(n = 20, 18.7%) and myalgia(n = 20, 18.7%). The duration of viral nucleic acid shedding of simple influenza A group, influenza A-pneumonia group, influenza A-underlying disease group, and influenza A-pneumonia-underlying disease group were 3.0 days(1.5, 5.0), 6.0 days(4.0, 10.0), 3.0 days(1.5, 6.5) and 6.0 days(3.0, 10.0), and differences between groups were statistically significant(P<0.05). The patients who received antiviral therapy within 48 hours after disease onset had significantly shorter duration of viral nucleic acid shedding and time of body temperature recovery than those who received antiviral therapy more than 48 hours after disease onset(P<0.01). Of all the adults with body temperature recovery,54.7% patients were still positive for viral nucleic acid. Conclusions Complicated pneumonia and no antiviral treatment within 48 hours of onset are the main factors for the longer duration of influenza A virus nucleic acid. Some patients may be positive for nucleic acid when they are discharged from the hospital. These patient should be isolated at home after discharge to avoid infecting others.