422例成人病毒感染肺炎临床特征分析

Clinical characteristics of 422 inpatients of viral pneumonia in adults

目的:了解成人病毒感染肺炎的病毒分布、临床特征及与病情严重程度相关的因素。方法:纳入2015年3月至2019年2月在上海交通大学医学院附属瑞金医院住院且呼吸道病毒检测阳性的肺炎患者,收集相关数据进行回顾性分析。结果:共纳入病毒感染肺炎患者422例,年龄范围为19~99岁,平均年龄(68±17)岁,男性256例(60.7%)。甲型流感病毒阳性159例(占37.7%),人鼻病毒阳性78例(占18.5%)。重症组鼻病毒及冠状病毒检出率、有吸烟史、体质量指数<18 kg/m 2以及有心力衰竭的患者比例均高于非重症组( χ2值分别为12.430、12.495、11.074、13.418、3.946, P值均<0.05),而高血压患者的比例低于非重症组( χ2=5.364, P<0.05)。重症组患者中呼吸困难较非重症组多见(63.2%比20.2%, χ2=80.534, P<0.05)。93.7%的重症患者感染累及多肺叶,且54.0%的重症患者细菌或真菌培养阳性,高于非重症组(64.9%、10.1%)( χ2值分别为47.433、97.519, P值均<0.05)。重症组外周血淋巴细胞总数及CD3 +、CD4 +、CD8 +细胞计数均低于非重症组( Z值分别为-6.440、-5.421、-4.551、-4.416, P值均<0.05),而血清IL-2R、IL-6、IL-10水平高于非重症组( Z值分别为-2.457、-3.554、-2.339, P值均<0.05)。多因素分析显示,吸烟史、高血压、多肺叶累及、合并细菌或真菌感染以及淋巴细胞计数与重症肺炎相关。 结论:甲型流感病毒是目前国内最常见的呼吸道感染病毒,鼻病毒次之;吸烟、多肺叶病变、合并细菌或真菌感染以及淋巴细胞减少是重症病毒感染肺炎的危险因素,且重症患者存在"细胞因子风暴"现象。

Objective To identify the virus distribution and clinical characteristics of the adult patients with viral pneumonia and the risk factors related to the disease severity.Methods In a retrospective cohort study,the inpatients with virus pneumonia whose respiratory virus test was positive in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from March 2015 to February 2019 were collected.Relevant clinical data were collected for further analysis.Results Among 422 cases of viral pneumonia,the age range was 19-99 years old,average age was(68±17)years old,256 cases(60.7%)were males.159 cases(37.7%)were positive for influenza A virus and 78 cases(18.5%)were positive for human rhinovirus.Compared to the non-severe group,the severe group showed higher detection rates of rhinovirus and coronavirus(OC43)(χ2=12.430,12.495,all P<0.05),higher proportions of patients with smoking history,body mass index<18 kg/m2,heart failure(χ2=11.074,13.418,3.946,all P<0.05),a lower proportion of patients with hypertension(χ2=5.364,P<0.05).The proportions of patients with dyspnea,multilobular infiltrates,positive bacterial or fungal culture in the severe group were higher than those in the non-severe group(63.2%vs 20.2%,93.7%vs 64.9%,54.0%vs 10.1%,χ2=80.534,47.433,97.519,all P<0.05).The total lymphocyte counts and lymphocyte subsets in peripheral blood of the severe group were lower than those of the non-severe group(Z=-6.440,-5.421,-4.551,-4.416,all P<0.05),while the serum levels of interleukin-2R,interleukin-6 and interleukin-10 in the severe group were more higher than those in the non-severe group(Z=-2.457,-3.554,-2.339,all P<0.05).Multivariate analysis further showed that smoking history,hypertension,multilobular infiltration,co-infection with bacterial or fungal and lymphocytopenia were associated with the disease severity.Conclusions Influenza A virus is the most common respiratory virus in Chinese patients with viral pneumonia,followed by rhinovirus.Smoking history,multilobular infiltration,co-infection with bacterial or fungal and lymphocytopenia may be the risk factors of severe viral pneumonia,and"cytokine storm"can be seen in the severe patients with viral pneumonia.