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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (01) : 63 -68. doi: 10.3877/cma.j.issn.1674-6902.2020.01.013

论著

流行性感冒合并肺炎临床特征分析
张曦木1, 张雪倩1, 冯聪1, 黎檀实1,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心急诊科
  • 收稿日期:2019-10-09 出版日期:2020-02-25
  • 通信作者: 黎檀实

Clinical characteristics of post-influenza pneumonia

Ximu Zhang1, Xueqian Zhang1, Cong Feng1, Tanshi Li1,†()   

  1. 1. Emergency Department, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2019-10-09 Published:2020-02-25
  • Corresponding author: Tanshi Li
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引用本文：

张曦木, 张雪倩, 冯聪, 黎檀实. 流行性感冒合并肺炎临床特征分析[J/OL]. 中华肺部疾病杂志(电子版), 2020, 13(01): 63-68.

Ximu Zhang, Xueqian Zhang, Cong Feng, Tanshi Li. Clinical characteristics of post-influenza pneumonia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(01): 63-68.

目的

探讨流行性感冒合并肺炎患者的临床症状、治疗及预后以加深对流行性感冒合并肺炎的了解。

方法

回顾性分析2017年11月至2018年3月就诊于解放军总医院的甲型流行性感冒合并肺炎68例、乙型流行性感冒合并肺炎66例患者的临床症状、辅助检查、治疗方法及预后情况。

结果

高热、乏力、干咳为流行性感冒合并肺炎最主要的首发症状，乙型流行性感冒合并肺炎患者既往患有糖尿病、支气管扩张病史的比例高于甲型流行性感冒合并肺炎，流行性感冒合并肺炎最易感染鲍曼不动杆菌及曲霉菌。9例(13.2%)甲型流行性感冒合并肺炎和5例(7.6%)乙型流行性感冒合并肺炎累及左肺，对其进行统计分析发现甲型流行性感冒合并肺炎和乙型流行性感冒合并肺炎在累及部位上无明显统计学意义。9例(13.2%)甲型流行性感冒合并肺炎和10例(15.2%)乙型流行性感冒合并肺炎合并胸腔积液；8例(11.8%)甲型流行性感冒合并肺炎和11例(16.6%)乙型流行性感冒合并肺炎11例仅表现为片状磨玻璃影；49例(72.0%)甲型流行性感冒合并肺炎和7例(10.2%)乙型流行性感冒合并肺炎7例(10.2%)表现为片状磨玻璃影和实变同存。7例(10.2%)甲型流行性感冒合并肺炎和11例(16.7%)乙型流行性感冒合并肺炎11例死亡。甲型流行性感冒合并肺炎和乙型流行性感冒合并肺炎在治疗、预后上无明显统计学差异(P>0.05)。

结论

流感高发季，如老年人出现高热、干咳、乏力等症状，生化提示乳酸脱氢酶升高，肺CT提示双肺弥漫性间质渗出、实变，应高度警惕流行性感冒合并肺炎的发生，早期进行治疗干预，乙型流行性感冒合并肺炎死亡率不低于甲型流行性感冒合并肺炎。

关键词: 流行性感冒, 肺炎, 临床特征, 病原学
Objective

To summarize the clinical symptoms, treatment and prognosis of the patients with post-influenza pneumonia in order to deepen the understanding of post-influenza pneumonia.

Methods

A retrospective analysis was made on the clinical symptoms, auxiliary examinations, treatment and prognosis of 68 cases of post-influenza A pneumonia and 66 cases of post-influenza B pneumonia in PLA General Hospital in Beijing from November 2017 to March 2018.

Results

Hyperpyrexia, fatigue and dry cough were the most common first symptoms of post-influenza pneumonia. The proportion of the patients with post-influenza B pneumonia suffering from previous diabetes mellitus and bronchiectasis was higher than that of the patients with post-influenza A pneumonia. Post-influenza pneumonia was most likely to be associated with acinetobacter baumannii and aspergillus infection. A statistical analysis of 9 cases (13.2%) of post-influenza A pneumonia and 5 cases (7.6%) of post-influenza B pneumonia involving the left lung found that post-influenza A pneumonia and post-influenza B pneumonia had no statistical significant difference in the area involved. Pleural effusion was found in 9 cases (13.2%) of post-influenza A pneumonia and 10 cases (15.2%) of post-influenza B pneumonia. Flake-like glass shadow was found only in 8 cases (11.8%) of post-influenza A pneumonia and 11 cases (16.6%) of post-influenza B pneumonia. Forty-nine cases (72.0%) of post-influenza A pneumonia and 7 cases (10.2%) of post-influenza B pneumonia were characterized by the existence of flake-like ground glass shadow and real change (χ2=54.278, P<0.01), with statistical significant difference. Seven cases (10.2%) of post-influenza A pneumonia and 11 cases (16.7%) of post-influenza B pneumonia were died. There was no significant difference in the treatment and prognosis of post-influenza A pneumonia and post-influenza B pneumonia (P>0.05).

Conclusion

During the influenza epidemic period, if the symptoms, such as hyperpyrexia, dry cough and fatigue in the elderly, increase the lactate dehydrogenase and pulmonary CT shows diffuse interstitial exudation and consolidation in both lungs, we should be highly alert to the occurrence of post-influenza pneumonia and make early treatment and intervention. The mortality rate of post-influenza B pneumonia is not less than that of post-influenza A pneumonia.

Key words: Influenza, Pneumonia, Clinical features, Etiology
表1 两组患者基本临床资料比较[n(%)]
临床资料 A组(n＝68) B组(n＝66) P值
性别(男/女) 42/26 48/18 0.177
年龄(岁) 51.4±18.3 65.5±19.6 0.000
糖尿病 4(6.0) 11(17.0) 0.048
高血压 14(21.0) 20(30.0) 0.916
冠心病 4/68(6.0) 6/66(9.0) 0.480
COPD 6/68(9.0) 6/66(9.0) 0.957
支气管扩张 2/68(3.0) 10/66(15.0) 0.012
表2 两组患者血常规、CRP结果比较
项　目 A组(n＝68) B组(n＝66) P值
血红蛋白(g/L) 130.9±21.7 126.9±25.5 0.335
白细胞(109/L) 7.8±4.8 9.9±7.6 0.062
中性粒细胞(%) 76.6±15.1 77.1±15.2 0.364
淋巴细胞(%) 14.9±9.8 13.9±9.2 0.522
单核细胞(%) 5.9±3.3 6.6±3.9 0.275
血小板(109/L) 181.6±72.3 183.1±80.9 0.825
C反应蛋白(mg/dl) 7.4±8.3 6.9±8.2 0.750
表3 两组患者生化结果比较
项　目 A组(n＝68) B组(n＝68) P值
丙氨酸氨基转移酶(IU/L) 40.2±31.2 43.6±72.5 0.789
门冬氨酸氨基转移酶(IU/L) 58.8±68.3 51.6±86.7 0.677
白蛋白(g/L) 33.9±5.6 33.8±7.1 0.949
总胆红素(μmol/L) 12.4±10.1 13.4±8.3 0.615
直接胆红素(μmol/L) 6.3±8.1 6.2±6.5 0.931
肌酐(μmol/L) 95.7±88.5 99.6±62.4 0.810
碱性磷酸酶(IU/L) 104.7±86.2 84.9±59.2 0.207
γ-谷氨酰转肽酶(IU/L) 81.1±83.4 56.6±65.3 0.125
乳酸脱氢酶(IU/L) 413.8±293.1 350.4±321.0 0.335
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