2016-2020年贵阳市老年呼吸道感染住院患者呼吸道合胞病毒流行特征及流感病毒感染临床严重性比较

曾强武 张凤丹 安仕刚 蹇孝丽 李芙蓉

曾强武, 张凤丹, 安仕刚, 蹇孝丽, 李芙蓉. 2016-2020年贵阳市老年呼吸道感染住院患者呼吸道合胞病毒流行特征及流感病毒感染临床严重性比较[J]. 疾病监测.
引用本文: 曾强武, 张凤丹, 安仕刚, 蹇孝丽, 李芙蓉. 2016-2020年贵阳市老年呼吸道感染住院患者呼吸道合胞病毒流行特征及流感病毒感染临床严重性比较[J]. 疾病监测.
Zeng Qiangwu, Zhang Fengdan, An Shigang, Jiang Xiaoli, Li Furong. Epidemiological characteristics and clinical severity of respiratory syncytial virus and influenza virus infections in hospitalized old patients with respiratory infection in Guiyang, 2016–2020[J]. Disease Surveillance.
Citation: Zeng Qiangwu, Zhang Fengdan, An Shigang, Jiang Xiaoli, Li Furong. Epidemiological characteristics and clinical severity of respiratory syncytial virus and influenza virus infections in hospitalized old patients with respiratory infection in Guiyang, 2016–2020[J]. Disease Surveillance.

2016-2020年贵阳市老年呼吸道感染住院患者呼吸道合胞病毒流行特征及流感病毒感染临床严重性比较

基金项目: 上海市浦东新区科委青年项目(No.PKJ2018-Y41)
详细信息
    作者简介:

    曾强武,男,贵州省黄平县人,副主任技师,主要从事临床血液/体液学检验、白血病形态学诊断和感染性疾病研究,Email:1134027931@qq.com

    通讯作者:

    李芙蓉,Tel:021-68135590-2218/2208,Email:lfrxuan@163.com

  • 曾强武和张凤丹对本文有同等贡献
  • 中图分类号: R211;R373.1

Epidemiological characteristics and clinical severity of respiratory syncytial virus and influenza virus infections in hospitalized old patients with respiratory infection in Guiyang, 2016–2020

Funds: This study was supported by the Youth Project of Science and Technology Commission of Shanghai Pudong New District (No.PKJ2018-Y41) and the Project of Science and Technology Commission of Guiyang Municipality ([2019]9-2-25)
More Information
  • 摘要:   目的  了解老年人呼吸道感染住院患者呼吸道合胞病毒(RSV)感染的流行病学特征,比较RSV感染与流感病毒感染的临床严重性差异,探索影响老年人呼吸道感染住院期间死亡的危险因素。  方法  收集2016年1月1日至2020年12月31日贵阳市2家医院收治的60岁以上老年人呼吸道感染住院患者的临床和病原学检测资料。比较RSV感染与流感病毒感染老年人在人口学特征、基础性疾病、临床表现,以及住院时间和住院期间死亡等临床结局上存在的差异,并采用多因素Logistic回归模型探索影响老年人呼吸道感染住院期间死亡的危险因素。  结果  5131例60岁以上呼吸道感染住院患者中,RSV检测阳性率为2%,流感病毒检测阳性率10%。77%(80/104)的RSV感染和63%(312/497)的流感病毒感染集中在每年的11月至次年2月,发病具有明显季节性。与流感病毒感染老年人比较,RSV感染的中位发病年龄(73岁 vs. 74岁,P=0.997),ICU收治比例(7% vs. 6%,P=0.822)和住院期间死亡率(6% vs. 3%,P=0.233)差异无统计学意义。但RSV感染的老年人中位住院天数延长(14 d vs. 12 d,P=0.041),入院时发热比例较低(50% vs. 61%,P=0.048)。5131人中,住院期间死亡114例(2%),RSV死亡6例(6%),流感病毒死亡15例(3%),多因素logistic回归分析结果显示,在调整性别、入院前抗生素使用比例后,80岁以上高龄(aOR=3.41, 95%CI=1.84≥~14.26)、具有基础性疾(aOR=2.34, 95%CI=1.12≥~4.91)、发病至就诊间隔超过7 d以上(aOR=8.94, 95%CI=1.60≥~29.99)、血氧饱和度低于90%(aOR=4.05, 95%CI=1.33≥~12.34),以及RSV感染(aOR=5.38, 95%CI=1.65≥~17.51)是老年人呼吸道感染死亡的独立危险因素。  结论  RSV感染增加贵阳地区老年人群呼吸道感染住院期间的死亡风险,且疾病较流感更为严重。临床大夫和公共卫生部门应给予老年人RSV感染高度关注,加强对RSV的监测、诊断和预防。
    1)  曾强武和张凤丹对本文有同等贡献
  • 图  1  老年人呼吸道合胞病毒与流感病毒相关呼吸道感染发病时间分布

    注:黑色曲线为阳性检测数的概率密度曲线

    Figure  1.  Time distribution of the elderly with RSV and influenza virus infections in Guiyang, 2016–2020

    表  1  老年人呼吸道合胞病毒与流感病毒相关呼吸道感染病例基本特征

    Table  1.   Basic characteristics of the elderly with RSV and influenza virus infections in Guiyang, 2016–2020

    特征呼吸道合胞病毒(n=104)流感病毒
    n=497)
    P
    性别0.370
     男性63(61)324(65)
     女性41(39)173(35)
    中位年龄,岁(IQR73(67~80) 74(66~81)0.997
    年龄组(岁)0.926
     60~35(34)168(34)
     70~40(38)182(37)
     ≥8029(28)147(30)
    基础性疾病27(26)146(29)0.552
    慢性阻塞性肺疾病19(18)108(22)0.509
     心脏疾病10(10) 48(10)1.000
     糖尿病 8(8) 33(7)0.366
     哮喘 2(2) 10(2)1.000
    入院前1周抗生素使用史a45/94(48)224/487(46)0.736
      注:如无特殊说明,表格中数值为频数(%);a 表示该变量存在缺失值
    下载: 导出CSV

    表  2  老年人RSV与流感病毒相关呼吸道感染住院病例临床严重性比较

    Table  2.   Comparison of the clinical severity of the elderly hospitalized due to RSV and influenza virus infections in Guiyang, 2016–2020

    特征呼吸道合胞病毒(n=104)流感病毒
    n=497)
    P
    症状/体征
     体温(℃,IQR)37.2(36.5~
    38.1)
    37.5(36.8~
    38.4)
    0.010
     呼吸频率(次/min,IQR)23(22~24)21(20~23)<0.001
     发热(体温≥37.2 ℃)52(50)302(61)0.048
     乏力11(11)62(12)0.741
     咳嗽96(92)454(91)0.849
     咳痰82(79)372(75)0.452
     胸痛9(9)33(7)0.524
     呼吸急促34(33)142(29)0.408
     肺部啰音a38/55(69)165/253(65)0.64
     呼吸困难16(15)79(16)1
    实验室检查
     白细胞计数异常a26/62(42)89/235(38)0.661
     淋巴细胞计数异常a25/50(50)102/189(54)0.636
     血小板计数异常a10/57(18)42/205(20)0.709
     血氧饱和度a(IQR)93(90~95)94(90~96)0.556
    住院天数a(IQR)14(5~30)12(6~23)0.041
    重症监护7(7)30(6)0.822
    死亡6(6)15(3)0.233
      注:表格中数值为频数(%);a 表示该变量存在缺失值。白细胞计数正常值范围4×109/L~9×109/L、淋巴细胞计数正常值范围1×109/L~3×109/L、血小板计数正常值范围100×109/L~350×109/L,超出上述正常值范围定义为异常
    下载: 导出CSV

    表  3  老年人呼吸道感染死亡危险因素多因素Logistic分析

    Table  3.   Multivariate Logistic regression results of risk factors of death in the elderly with respiratory tract infection in Guiyang, 2016–2020

    特征病例数(例)死亡数(例)病死率(%)死亡(n=114)
    OR(95%CIaOR(95%CI
    性别
     男性3330772.3Ref.Ref.
     女性1801372.10.71(0.22~2.26)0.74(0.22~2.49)
    年龄组(岁)
     60~1818281.5Ref.Ref.
     70~1874402.11.64(0.39~6.93)1.66(0.37~7.40)
     ≥801439463.22.56(1.6710.69)3.41(1.8414.26)
    基础性疾病
     否4030822.0Ref.Ref.
     是1101322.92.01(1.073.73)2.34(1.124.91)
    影像学肺炎表现
     否2388341.4Ref.Ref.
     是2743802.91.12(0.62~2.05)1.53(0.76~3.09)
    发病至就诊时间(d)a
     <3975262.7Ref.Ref.
     3~1024323.12.58(0.49~13.4)3.10(0.54~17.85)
     >7555224.06.62(1.3921.6)8.94(1.6029.99)
    血氧饱和度<90% a
     否1675311.9Ref.Ref.
     是707273.83.09(1.18.64)4.05(1.3312.34)
    入院前抗生素使用a
     否1675442.6Ref.Ref.
     是2216311.40.53(0.290.98)0.57(0.31~1.07)
    呼吸道合胞病毒
     阴性50271082.1Ref.Ref.
     阳性10465.85.97(2.0117.72)5.38(1.6517.51)
    流感病毒
     阴性4631992.1Ref.Ref.
     阳性497153.02.02(0.93~4.40)1.94(0.87~4.33)
      注:a 表示该变量存在缺失值;Ref.参照组
    下载: 导出CSV
  • [1] Mazur NI, Higgins D, Nunes MC, et al. The respiratory syncytial virus vaccine landscape: lessons from the graveyard and promising candidates[J]. Lancet Infect Dis, 2018, 18(10): e295–e311. DOI: 10.1016/s1473−3099(18)30292−5.
    [2] Shi T, Mcallister DA, O'Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study[J]. Lancet, 2017, 390(10098): 946–958. DOI: 10.1016/S0140−6736(17)30938−8.
    [3] Thompson WW, Shay DK, Weintraub E, et al. Mortality associated with influenza and respiratory syncytial virus in the United States[J]. JAMA, 2003, 289(2): 179–186. DOI:  10.1001/jama.289.2.179.
    [4] Falsey AR, Hennessey PA, Formica MA, et al. Respiratory syncytial virus infection in elderly and high-risk adults[J]. N Engl J Med, 2005, 352(17): 1749–1759. DOI:  10.1056/NEJMoa043951.
    [5] Sethi S, Murphy TF. RSV infection-not for kids only[J]. N Engl J Med, 2005, 352(17): 1810–1812. DOI:  10.1056/NEJMe058036.
    [6] Branche AR, Falsey AR. Respiratory syncytial virus infection in older adults: an under-recognized problem[J]. Drugs Aging, 2015, 32(4): 261–269. DOI: 10.1007/s40266−015−0258−9.
    [7] Killikelly A, Tunis M, House A, et al. Overview of the respiratory syncytial virus vaccine candidate pipeline in Canada[J]. Can Commun Dis Rep, 2020, 46(4): 56–61. DOI:  10.14745/ccdr.v46i04a01.
    [8] Giersing BK, Karron RA, Vekemans J, et al. Meeting report: WHO consultation on Respiratory Syncytial Virus (RSV) vaccine development, Geneva, 25-26 April 2016[J]. Vaccine, 2019, 37(50): 7355–7362. DOI:  10.1016/j.vaccine.2017.02.068.
    [9] 黎孟枫, 任丽丽, 余宏杰. 发热呼吸道症候群病原学监测与检测技术[M]. 广州: 中山大学出版社, 2017.

    Li MF, Ren, LL, Yu, HJ. Pathogen surveillance and detection techniques: febrile respiratory syndrome[M]. Guangzhou: Sun Yat-sen University Press, 2017.
    [10] Li L, Liu YN, Wu P, et al. Influenza-associated excess respiratory mortality in China, 2010-15: a population-based study[J]. Lancet Public Health, 2019, 4(9): e473–e481. DOI: 10.1016/S2468−2667(19)30163−X.
    [11] Weinstein RA, Hall CB. Nosocomial respiratory syncytial virus infections: the "Cold War" has not ended[J]. Clin Infect Dis, 2000, 31(2): 590–596. DOI:  10.1086/313960.
    [12] Griffiths C, Drews SJ, Marchant DJ. Respiratory syncytial virus: infection, detection, and new options for prevention and treatment[J]. Clin Microbiol Rev, 2017, 30(1): 277–319. DOI: 10.1128/CMR.00010−16.
    [13] Boonyaratanakornkit J, Ekici S, Magaret A, et al. Respiratory syncytial virus infection in homeless populations, Washington, USA[J]. Emerg Infect Dis, 2019, 25(7): 1408–1411. DOI:  10.3201/eid2507.181261.
    [14] Sorvillo FJ, Huie SF, Strassburg MA, et al. An outbreak of respiratory syncytial virus pneumonia in a nursing home for the elderly[J]. J Infect, 1984, 9(3): 252–256. DOI: 10.1016/s0163−4453(84)90530−9.
    [15] De Bree GJ, Heidema J, Van Leeuwen EMM, et al. Respiratory syncytial virus-specific CD8+ memory T cell responses in elderly persons[J]. J Infect Dis, 2005, 191(10): 1710–1718. DOI:  10.1086/429695.
    [16] Nicholson KG, Kent J, Hammersley V, et al. Acute viral infections of upper respiratory tract in elderly people living in the community: comparative, prospective, population based study of disease burden[J]. BMJ, 1997, 315(7115): 1060–1064. DOI:  10.1136/bmj.315.7115.1060.
    [17] Ackerson B, Tseng HF, Sy LS, et al. Severe morbidity and mortality associated with respiratory syncytial virus versus influenza infection in hospitalized older adults[J]. Clin Infect Dis, 2019, 69(2): 197–203. DOI:  10.1093/cid/ciy991.
    [18] Ivey KS, Edwards KM, Talbot HK. Respiratory syncytial virus and associations with cardiovascular disease in adults[J]. J Am Coll Cardiol, 2018, 71(14): 1574–1583. DOI:  10.1016/j.jacc.2018.02.013.
    [19] Zhou MG, Wang HD, Zeng XY, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the global burden of disease study 2017[J]. The Lancet, 2019, 394(10204): 1145–1158. DOI: 10.1016/s0140−6736(19)30427−1.
    [20] Yu HJ, Alonso WJ, Feng LZ, et al. Characterization of regional influenza seasonality patterns in China and implications for vaccination strategies: spatio-temporal modeling of surveillance data[J]. PLoS Med, 2013, 10(11): e1001552. DOI:  10.1371/journal.pmed.1001552.
    [21] Obando-Pacheco P, Justicia-Grande A J, Rivero-Calle I, et al. Respiratory syncytial virus seasonality: a global overview[J]. J Infect Dis, 2018, 217(9): 1356–1364. DOI:  10.1093/infdis/jiy056.
    [22] Uyeki TM. Influenza[J]. Ann Intern Med, 2017, 167(5): ITC33–ITC48. DOI:  10.7326/AITC201709050.
    [23] Call SA, Vollenweider MA, Hornung CA, et al. Does this patient have influenza?[J]. JAMA, 2005, 293(8): 987–997. DOI:  10.1001/jama.293.8.987.
    [24] Saha S, Pandey BG, Choudekar A, et al. Evaluation of case definitions for estimation of respiratory syncytial virus associated hospitalizations among children in a rural community of northern India[J]. J Global Health, 2015, 5(2): 010419. DOI:  10.7189/jogh.05.020419.
    [25] De Zwart AES, Riezebos-Brilman A, Kerstjens HAM, et al. Respiratory syncytial virus infection morbidity in the elderly: time for repurposing of ribavirin?[J]. Clin Infect Dis, 2020, 70(10): 2238–2239. DOI:  10.1093/cid/ciz835.
  • 加载中
图(1) / 表(3)
计量
  • 文章访问数:  94
  • HTML全文浏览量:  71
  • PDF下载量:  12
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-06-01

目录

    /

    返回文章
    返回

    在线交流

    防诈骗公告

    近期有不法分子以本刊编辑身份添加作者微信,请务必提高警惕!本刊关于稿件的一切事项通知均采用编辑部唯一邮箱(jbjc@icdc.cn)和座机(010-58900732)联系作者,且在录用稿件后仅收取版面费,无其他任何名目费用(如审稿费和加急费等),非编辑部邮箱发送的本刊收费用通知等均为诈骗,不要随意汇入款项!如有可疑及时致电编辑部核实确认!