Antiviral therapy and outcomes of patients with pneumonia caused by influenza A pandemic (H1N1) virus.
Antiviral therapy and outcomes of patients with pneumonia caused by influenza A pandemic (H1N1) virus.
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甲型流感大流行 (H1N1) 病毒引起的肺炎患者的抗病毒治疗和结果
DOI：
10.1371/journal.pone.0029652
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
National Influenza A Pandemic (H1N1) 2009 Clinical Investigation Group of China
中科院分区：
文献类型：
--
作者：
Yang SG;Cao B;Liang LR;Li XL;Xiao YH;Cao ZX;Jia HY;Yu HJ;Xu Z;Gu L;Yang YD;Chen Y;Du WB;Yan XX;Liang ZA;Zhang W;Zhang CL;Chen W;Guo CP;Jiang XL;Yang M;Deng GM;Yu KJ;Hu K;Zou Q;Li LJ;Wang C;National Influenza A Pandemic (H1N1) 2009 Clinical Investigation Group of China
背景关于接受奥司他韦治疗的大流行性H1N1（pH 1 N1）肺炎患者的临床结局数据有限，特别是在症状发作后超过48小时给予治疗时。方法在2009年流感大流行期间建立pH 1 N1流感肺炎队列，系统收集其临床资料，采用考克斯模型进行分析。结果分析了920例成人和541例儿童肺炎患者未接受糖皮质激素治疗的情况。未接受抗病毒治疗的成人住院死亡率（18.2%）高于发病后≤ 2天、2-5天和>5天接受奥司他韦治疗的成人（2.9%），p<0.01。在儿科患者中也观察到类似的趋势。考克斯回归分析显示，在症状发作后60天，11例（10.8%）未接受抗病毒药物治疗的患者死亡，而奥司他韦治疗开始≤ 2天、2- 5天和>5天的患者分别为4例（1.8%）、18例（3.3%）和23例（3.7%）。对于年龄≥ 14岁且基线PaO 2/FiO 2 <200的男性患者，奥司他韦给药分别使死亡风险降低92.1%、88%和83.5%。较高剂量的奥司他韦（>3.8 mg/kg/d）并未改善临床结局（死亡率，较高剂量为2.5%，标准剂量为2.8%，p>0.05）。结论抗病毒治疗可降低pH 1 N1肺炎患者的死亡率，即使是在发病后48小时开始。男性、14-60岁患者和PaO 2/FiO 2 <200的患者可能具有更大的保护作用。
Background There is limited data on the clinical outcome of patients with pandemic H1N1 (pH1N1) pneumonia who received oseltamivir treatment, especially when the treatment was administered more than 48 hours after symptom onset. Methods During the pandemic in 2009, a cohort of pH1N1 influenza pneumonia was built in China, and their clinical information was collected systematically, and analyzed with Cox models. Results 920 adults and 541 children with pneumonia who didn't receive corticosteroids were analyzed. In-hospital mortality was higher in adults who did not receive antiviral therapy (18.2%) than those with who received oseltamivir ≤ 2days (2.9%), between 2–5 days (4.6%) and >5 days after illness onset (4.9%), p<0.01. A similar trend was observed in pediatric patients. Cox regression showed that at 60 days after symptoms onset, 11 patients (10.8%) who did not receive antivirals died versus 4 (1.8%), 18 (3.3%), and 23 (3.7%) patients whose oseltamivir treatment was started ≤ 2days, between 2–5days, and >5 days, respectively. For males patients, aged ≥ 14 years and baseline PaO2/FiO2<200, oseltamivir administration reduced the mortality risk by 92.1%, 88% and 83.5%, respectively. Higher doses of oseltamivir (>3.8 mg/kg/d) did not improve clinical outcome (mortality, higher dose 2.5% vs standard dose 2.8%, p>0.05). Conclusions Antiviral therapy might reduce mortality of patients with pH1N1 pneumonia, even when initiated more than 48 hours after onset of illness. Greater protective effects might be in males, patients aged 14–60 years, and patients with PaO2/FiO2<200.
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影响因子：
168.9
作者：
Jamieson, Denise J.;Honein, Margaret A.;Olsen, Sonja J.
通讯作者：
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DOI：
10.1136/bmj.b5106
发表时间：
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期刊：
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