老年呼吸道病毒感染119例临床特征分析

doi:10.3969/j.issn.1674-8115.2021.05.011

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (5): 628-631.doi: 10.3969/j.issn.1674-8115.2021.05.011

老年呼吸道病毒感染119例临床特征分析

黄道¹(), 韦栋², 徐志红¹(), 胡家安¹()

^1.上海交通大学医学院附属瑞金医院老年病科，上海 200025
^2.上海交通大学医学院附属瑞金医院感染病与呼吸病研究所临床病毒研究室，上海 200025

出版日期:2021-05-28 发布日期:2021-05-27
通讯作者: 徐志红,胡家安 E-mail:hd12156@rjh.com.cn;zhihxu@163.com;jahu_rj@aliyun.com
作者简介:黄道（1987—），男，主治医师，博士；电子信箱：hd12156@rjh.com.cn。
基金资助:
上海市卫生和计划生育委员会科研课题(201840083);上海市卫生和计划生育委员会重要薄弱学科建设计划(2015ZB0503);上海市高校产学研课题(RC20190079)

Clinical features of 119 old patients with respiratory virus infection

Dao HUANG¹(), Dong WEI², Zhi-hong XU¹(), Jia-an HU¹()

^1.Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
^2.Clinical Virology Laboratory, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Online:2021-05-28 Published:2021-05-27
Contact: Zhi-hong XU,Jia-an HU E-mail:hd12156@rjh.com.cn;zhihxu@163.com;jahu_rj@aliyun.com
Supported by:
Scientific Research Project of Shanghai Municipal Commission of Health and Family Planning(201840083);Important Weak Discipline Construction Program of Shanghai Municipal Commission of Health and Family Planning(2015ZB0503);Shanghai Universities Research Project of Production, Education and Research(RC20190079)

摘要/Abstract

摘要：

目的·分析老年呼吸道病毒感染病例的临床特征以及影响临床结局的可能因素。方法·共入组上海交通大学医学院附属瑞金医院老年病科确诊为呼吸道病毒感染的119例住院患者（年龄≥65岁），分析患者的临床症状、实验室检查结果、治疗经过及转归，并比较治愈患者与死亡患者的各项指标。结果·入选患者平均年龄（85.61±7.67）岁，男性98例，女性21例；死亡病例12例。其中，流行性感冒病毒A型感染患者最多（41例）。与治愈患者比较，死亡患者年龄更大，合并细菌感染、胸部CT出现双肺炎症的比例更高（均P<0.05）；在入院时实验室检查中，治愈患者与死亡患者的白细胞、中性粒细胞、红细胞计数，血红蛋白、白蛋白、尿素、肌酐水平，及估算肾小球滤过率比较，差异均有统计学意义（均P<0.05）。结论·年龄偏大，白细胞计数、中性粒细胞计数偏高，血红蛋白、白蛋白水平偏低，肾功能不全，合并有细菌感染可能是老年呼吸道病毒感染患者死亡的影响因素。

关键词: 老年人, 呼吸道病毒感染, 临床特征

Abstract:

Objective·To analyze the clinical features and risk factors that possibly affect the clinical outcome of elderly patients with respiratory virus infection.

Methods·A total of 119 hospitalized patients (≥65 years old) with respiratory virus infection in the Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were enrolled in this study. The clinical symptoms, laboratory examination, treatment course and outcome were analyzed and compared between cured patients and dead patients.

Results·The average age of the patients was (85.61±7.67) years old, the male to female ratio was 98∶21 and 12 cases were dead. The number of influenza A virus patients (41 cases) was the most. Compared with cured patients, the dead patients were older, and the proportion of cases with bacterial infection or with double pneumonia in chest CT was higher (P<0.05). In the laboratory examination on admission, there were significant differences between the cured patients and the dead patients on leukocyte count, neutrophil count, erythrocyte count, the levels of hemoglobin, serum albumin, urea, and creatinine, and estimated glomerular filtration rate (P<0.05).

Conclusion·Older age, higher leukocyte count and neutrophil count, lower hemoglobin and albumin levels, renal insufficiency and bacterial infection may be the influencing factors of death in elderly patients with respiratory virus infection.

Key words: the elderly, respiratory virus infection, clinical features

中图分类号:

R563.1

黄道, 韦栋, 徐志红, 胡家安. 老年呼吸道病毒感染119例临床特征分析[J]. 上海交通大学学报(医学版), 2021, 41(5): 628-631.

Dao HUANG, Dong WEI, Zhi-hong XU, Jia-an HU. Clinical features of 119 old patients with respiratory virus infection[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(5): 628-631.

图/表 2

参考文献 17

1	Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study[J]. Lancet, 2018, 391(10127): 1285-1300.
2	van Asten L, van den Wijngaard C, van Pelt W, et al. Mortality attributable to 9 common infections: significant effect of influenza A, respiratory syncytial virus, influenza B, norovirus, and parainfluenza in elderly persons[J]. J Infect Dis, 2012, 206(5): 628-639.
3	Ruuskanen O, Lahti E, Jennings LC, et al. Viral pneumonia [J]. Lancet, 2011, 377(9773): 1264-1275.
4	Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults [J]. N Engl J Med, 2015, 373(5): 415-427.
5	Qu JX, Gu L, Pu ZH, et al. Viral etiology of community-acquired pneumonia among adolescents and adults with mild or moderate severity and its relation to age and severity[J]. BMC Infect Dis, 2015, 15: 89.
6	Gong C, Zhang TG, Luo M, et al. Distribution of the atypical pathogens of community-acquired pneumonia to disease severity[J]. J Thorac Dis, 2018, 10(11): 5991-6001.
7	Tao RJ, Luo XL, Xu W, et al. Viral infection in community acquired pneumonia patients with fever: a prospective observational study[J]. J Thorac Dis, 2018, 10(7): 4387-4395.
8	Zhan Y, Yang Z, Chen R, et al. Respiratory virus is a real pathogen in immunocompetent community-acquired pneumonia: comparing to influenza like illness and volunteer controls[J]. BMC Pulm Med, 2014, 14: 144.
9	Zhou F, Wang Y, Liu Y, et al. Disease severity and clinical outcomes of community-acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicentre prospective registry study from the CAP-China Network [J]. Eur Respir J, 2019, 54(2): 1802406.
10	Widmer K, Zhu Y, Williams JV, et al. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults[J]. J Infect Dis, 2012, 206(1): 56-62.
11	Widmer K, Griffin MR, Zhu Y, et al. Respiratory syncytial virus and human metapneumovirus-associated emergency department and hospital burden in adults[J]. Influenza Other Respir Viruses, 2014, 8(3): 347-352.
12	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.
13	Lee N, Lui GC, Wong KT, et al. High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections[J]. Clin Infect Dis, 2013, 57(8): 1069-1077.
14	Voiriot G, Visseaux B, Cohen J, et al. Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia[J]. Crit Care, 2016, 20(1): 1-9.
15	Joseph C, Togawa Y, Shindo N. Bacterial and viral infections associated with influenza[J]. Influenza Other Respir Viruses, 2013, 7(): 105-113.
16	Yee C, Suarthana E, Dendukuri N, et al. Evaluating the impact of the multiplex respiratory virus panel polymerase chain reaction test on the clinical management of suspected respiratory viral infections in adult patients in a hospital setting[J]. Am J Infect Control, 2016, 44(11): 1396-1398.
17	Branche AR, Walsh EE, Vargas R, et al. Serum procalcitonin measurement and viral testing to guide antibiotic use for respiratory infections in hospitalized adults: a randomized controlled trial[J]. J Infect Dis, 2015, 212(11): 1692-1700.

Item	Value
Leukocyte count/(×10⁹·L^-1)	7.47±4.14
Neutrophil count/(×10⁹·L^-1)	5.67±3.99
Lymphocyte count/(×10⁹·L^-1)	1.17±0.86
Monocyte count/(×10⁹·L^-1)	0.85±3.21
Erythrocyte count/(×10¹²·L^-1)	3.80±0.84
Hemoglobin/(g·L^-1)	117.41±22.32
Platelet count/(×10⁹·L^-1)	178.64±78.72
Glutamic-pyruvic transaminase/(IU·L^-1)	24.97±55.40
Glutamic-oxaloacetic transaminase/(IU·L^-1)	36.74±76.29
Total bilirubin/(μmol·L^-1)	12.44±6.00
Albumin/(g·L^-1)	34.12±7.03
Urea nitrogen/(mmol·L^-1)	9.30±9.15
Creatinine/(μmol·L^-1)	108.67±81.91
Trioxypurine/(μmol·L^-1)	306.55±107.54
eGFR/(mL·min^-1)	78.27±36.04
Serum natrium/(mmol·L^-1)	137.56±5.05
Serum kalium/(mmol·L^-1)	3.95±0.49
Pro-B-type natriuretic peptide/(pg·mL^-1)	2 310.05±6 547.68
C-reactive protein/(mg·L^-1)	34.24±49.92
Erythrocyte sedimentation rate/(mm·h^-1)	27.39±26.41
Procalcitonin/(ng·mL^-1)	1.37±7.21
Endotoxin (limulus test)/(pg·mL^-1)	22.39±60.55
Pulmonary inflammation showed on chest CT/% (n/n)	53.9 （62/115）
Bilateral pulmonary inflammation showed on chest CT/% (n/n)	41.7 （48/115）

Item	Value
Leukocyte count/(×10⁹·L^-1)	7.47±4.14
Neutrophil count/(×10⁹·L^-1)	5.67±3.99
Lymphocyte count/(×10⁹·L^-1)	1.17±0.86
Monocyte count/(×10⁹·L^-1)	0.85±3.21
Erythrocyte count/(×10¹²·L^-1)	3.80±0.84
Hemoglobin/(g·L^-1)	117.41±22.32
Platelet count/(×10⁹·L^-1)	178.64±78.72
Glutamic-pyruvic transaminase/(IU·L^-1)	24.97±55.40
Glutamic-oxaloacetic transaminase/(IU·L^-1)	36.74±76.29
Total bilirubin/(μmol·L^-1)	12.44±6.00
Albumin/(g·L^-1)	34.12±7.03
Urea nitrogen/(mmol·L^-1)	9.30±9.15
Creatinine/(μmol·L^-1)	108.67±81.91
Trioxypurine/(μmol·L^-1)	306.55±107.54
eGFR/(mL·min^-1)	78.27±36.04
Serum natrium/(mmol·L^-1)	137.56±5.05
Serum kalium/(mmol·L^-1)	3.95±0.49
Pro-B-type natriuretic peptide/(pg·mL^-1)	2 310.05±6 547.68
C-reactive protein/(mg·L^-1)	34.24±49.92
Erythrocyte sedimentation rate/(mm·h^-1)	27.39±26.41
Procalcitonin/(ng·mL^-1)	1.37±7.21
Endotoxin (limulus test)/(pg·mL^-1)	22.39±60.55
Pulmonary inflammation showed on chest CT/% (n/n)	53.9 （62/115）
Bilateral pulmonary inflammation showed on chest CT/% (n/n)	41.7 （48/115）

Item	Cured cases (n=107)	Death cases (n=12)	P value
Male/n(%)	89 (83.2)	9 (75.0)	0.442
Age/year	85.10±7.86	89.80±3.84	0.002
Temperature/℃	37.29±0.71	37.02±0.63	0.201
Complication/n(%)
Diabetes	28 (26.2)	3 (25.0)	1.000
Hypertension	80 (74.8)	9 (75.0)	1.000
Coronary heart disease	10 (9.3)	1 (8.3)	1.000
Cardiac failure	32 (29.9)	5 (41.7)	0.512
Cerebral stroke	8 (7.5)	1 (8.3)	1.000
Chronic obstructive pulmonary disease	13 (12.1)	4 (33.3)	0.069
Cancer	33 (30.8)	3 (25.0)	1.000
Chronic kidney disease	56 (52.3)	9 (75.0)	0.221
Complicated with bacterial infection	31 (33.0)	8 (66.7)	0.029
Smoking or prior smoking	22 (20.6)	5 (41.7)	0.140
Leukocyte count/(×10⁹·L^-1)	7.14±3.86	10.39±5.49	0.009
Neutrophil count/(×10⁹·L^-1)	5.35±3.71	8.55±5.34	0.008
Lymphocyte count/(×10⁹·L^-1)	1.17±0.87	1.15±0.81	0.939
Monocyte count/(×10⁹·L^-1)	0.89±3.38	0.51±0.24	0.703
Erythrocyte count/(×10¹²·L^-1)	3.89±0.83	3.06±0.55	0.001
Hemoglobin/(g·L^-1)	120.00±21.03	94.33±20.88	0.001
Platelet count/(×10⁹·L^-1)	178.09±77.34	183.58±93.79	0.820
Glutamic-pyruvic transaminase/(IU·L^-1)	25.80±58.24	17.58±13.41	0.628
Glutamic-oxaloacetic transaminase/(IU·L^-1)	33.13±61.19	68.92±158.41	0.454
Total bilirubin/(μmol·L^-1)	12.43±6.08	12.53±5.46	0.955
Albumin/(g·L^-1)	34.84±6.89	27.67±4.83	0.001
Urea nitrogen/(mmol·L^-1)	8.32±8.07	17.97±12.32	0.030
Creatinine/(μmol·L^-1)	95.14±40.45	229.33±196.30	0.037
Trioxypurine/(μmol·L^-1)	302.45±105.22	342.75±125.44	0.220
eGFR/(mL·min^-1)	81.52±34.61	49.24±36.98	0.003
Serum natrium/(mmol·L^-1)	137.55±4.79	137.67±7.22	0.941
Serum kalium/(mmol·L^-1)	3.92±0.44	4.27±0.78	0.142
Pro-B-type natriuretic peptide/(pg·mL^-1)	1 677.66±5 153.01	7 948.88±12 862.50	0.121
C-reactive protein/(mg·L^-1)	31.29±46.73	60.61±69.57	0.180
Erythrocyte sedimentation rate/(mm·h^-1)	25.68±25.02	44.88±35.24	0.172
Procalcitonin/(ng·mL^-1)	1.52±7.62	0.19±0.18	0.549
Endotoxin (limulus test)/(pg·mL^-1)	24.11±63.83	7.8±0.00	0.380
Bilateral pulmonary inflammation showed on chest CT/n(%)	39 (37.9)	9 (75.0)	0.044
Days of using antibiotics/d	10.24±4.22	11.33±2.78	0.386

Item	Cured cases (n=107)	Death cases (n=12)	P value
Male/n(%)	89 (83.2)	9 (75.0)	0.442
Age/year	85.10±7.86	89.80±3.84	0.002
Temperature/℃	37.29±0.71	37.02±0.63	0.201
Complication/n(%)
Diabetes	28 (26.2)	3 (25.0)	1.000
Hypertension	80 (74.8)	9 (75.0)	1.000
Coronary heart disease	10 (9.3)	1 (8.3)	1.000
Cardiac failure	32 (29.9)	5 (41.7)	0.512
Cerebral stroke	8 (7.5)	1 (8.3)	1.000
Chronic obstructive pulmonary disease	13 (12.1)	4 (33.3)	0.069
Cancer	33 (30.8)	3 (25.0)	1.000
Chronic kidney disease	56 (52.3)	9 (75.0)	0.221
Complicated with bacterial infection	31 (33.0)	8 (66.7)	0.029
Smoking or prior smoking	22 (20.6)	5 (41.7)	0.140
Leukocyte count/(×10⁹·L^-1)	7.14±3.86	10.39±5.49	0.009
Neutrophil count/(×10⁹·L^-1)	5.35±3.71	8.55±5.34	0.008
Lymphocyte count/(×10⁹·L^-1)	1.17±0.87	1.15±0.81	0.939
Monocyte count/(×10⁹·L^-1)	0.89±3.38	0.51±0.24	0.703
Erythrocyte count/(×10¹²·L^-1)	3.89±0.83	3.06±0.55	0.001
Hemoglobin/(g·L^-1)	120.00±21.03	94.33±20.88	0.001
Platelet count/(×10⁹·L^-1)	178.09±77.34	183.58±93.79	0.820
Glutamic-pyruvic transaminase/(IU·L^-1)	25.80±58.24	17.58±13.41	0.628
Glutamic-oxaloacetic transaminase/(IU·L^-1)	33.13±61.19	68.92±158.41	0.454
Total bilirubin/(μmol·L^-1)	12.43±6.08	12.53±5.46	0.955
Albumin/(g·L^-1)	34.84±6.89	27.67±4.83	0.001
Urea nitrogen/(mmol·L^-1)	8.32±8.07	17.97±12.32	0.030
Creatinine/(μmol·L^-1)	95.14±40.45	229.33±196.30	0.037
Trioxypurine/(μmol·L^-1)	302.45±105.22	342.75±125.44	0.220
eGFR/(mL·min^-1)	81.52±34.61	49.24±36.98	0.003
Serum natrium/(mmol·L^-1)	137.55±4.79	137.67±7.22	0.941
Serum kalium/(mmol·L^-1)	3.92±0.44	4.27±0.78	0.142
Pro-B-type natriuretic peptide/(pg·mL^-1)	1 677.66±5 153.01	7 948.88±12 862.50	0.121
C-reactive protein/(mg·L^-1)	31.29±46.73	60.61±69.57	0.180
Erythrocyte sedimentation rate/(mm·h^-1)	25.68±25.02	44.88±35.24	0.172
Procalcitonin/(ng·mL^-1)	1.52±7.62	0.19±0.18	0.549
Endotoxin (limulus test)/(pg·mL^-1)	24.11±63.83	7.8±0.00	0.380
Bilateral pulmonary inflammation showed on chest CT/n(%)	39 (37.9)	9 (75.0)	0.044
Days of using antibiotics/d	10.24±4.22	11.33±2.78	0.386

[1]	代华杰, 禤立平, 项家丽, 林泓, 赵志云, 王天歌, 李勉, 徐瑜, 陆洁莉, 王卫庆, 毕宇芳, 徐敏. 上海市社区中老年人群健康的血管衰老和心血管疾病患病风险的相关性研究[J]. 上海交通大学学报(医学版), 2021, 41(2): 223-227.
[2]	管红艳，刘婧娴，刘瑛. 分离自血培养肺炎克雷伯菌的毒力基因及患者临床特征分析[J]. 上海交通大学学报（医学版）, 2020, 40(2): 235-.
[3]	栾伟1, 2，朱珠2，朱冬平2，葛文静2，朱群妹3，蒋燕勤2，李劲2，姜安丽1. 城乡结合社区老年人健康促进生活方式与社会支持、自我效能感相关性研究[J]. 上海交通大学学报（医学版）, 2020, 40(1): 107-.
[4]	马银珠，陆光华，钟娜，王海红，和申，赵雪，江海峰，王振. 酒精所致精神病性障碍男性患者临床特征及危险因素[J]. 上海交通大学学报(医学版), 2020, 40(09): 1256-1262.
[5]	祖娟，钱方媛，吴迪，谢新欣，任庆国，张志珺. 成年晚发型糖原贮积症Ⅱ型临床特征及基因突变分析[J]. 上海交通大学学报(医学版), 2020, 40(08): 1108-1112.
[6]	曾素，许培培，郭明高. 具有乳头样核特征的非浸润性甲状腺滤泡性肿瘤的临床研究进展[J]. 上海交通大学学报(医学版), 2020, 40(07): 968-973.
[7]	吕娜，叶惠玲，范青#，肖泽萍#. 伴囤积症状强迫症患者的临床特征研究[J]. 上海交通大学学报(医学版), 2020, 40(06): 791-797.
[8]	姜涛 1, 2，施晴 1，许彭鹏 1，程澍 1，王黎 1，赵维莅 1. 肾上腺淋巴瘤临床病理特点及预后因素分析[J]. 上海交通大学学报（医学版）, 2019, 39(9): 1032-.
[9]	盛长生，黄绮芳，黄剑峰，李燕，王继光. 上海老年人四肢血压差别异常的患病情况及相关因素[J]. 上海交通大学学报（医学版）, 2019, 39(3): 287-.
[10]	路会萍，吴李娜，汪海娅. 社区门诊老年高血压患者自测健康调查及其影响因素分析[J]. 上海交通大学学报（医学版）, 2019, 39(10): 1194-.
[11]	刘霞 1, 2，丁飚 3，章雅青 1. 经皮冠状动脉介入治疗老年患者焦虑、抑郁情绪与睡眠质量及生活质量的相关性[J]. 上海交通大学学报（医学版）, 2018, 38(9): 1085-.
[12]	董凤伟，马佳莉，张莹. 合并慢性病的老年心房颤动患者消融术后复发危险因素研究[J]. 上海交通大学学报（医学版）, 2018, 38(9): 1092-.
[13]	陈珺珏，田琳璐，韦严，亢晓丽. X染色体连锁显性遗传婴儿眼球震颤家系的临床特征研究[J]. 上海交通大学学报（医学版）, 2018, 38(11): 1355-.
[14]	吴雪妍，程棣，马丽娜，林琳，杜瑞，徐瑜，徐敏，毕宇芳，王卫庆，陆洁莉. 中国中老年社区人群肥胖与慢性肾脏疾病的相关性研究[J]. 上海交通大学学报（医学版）, 2017, 37(9): 1213-.
[15]	侯亚楠，禤立平，彭魁，杜瑞，徐瑜，陈宇红，陆洁莉，毕宇芳，徐敏，王卫庆，宁光 . 社区中老年人群中上臂围与非酒精性脂肪性肝病及胰岛素抵抗的相关性研究[J]. 上海交通大学学报（医学版）, 2017, 37(9): 1232-.

老年呼吸道病毒感染119例临床特征分析

Clinical features of 119 old patients with respiratory virus infection

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 2

参考文献 17

相关文章 15

编辑推荐

Metrics