Pulmonary complications of interpandemic influenza A in hospitalized adults
Pulmonary complications of interpandemic influenza A in hospitalized adults
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DOI：
10.1086/512160
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发表时间：
2007-04-01
影响因子：
6.4
通讯作者：
Falsey, Ann R.
中科院分区：
文献类型：
--
作者：
Murata, Yoshihiko;Walsh, Edward E.;Falsey, Ann R.
背景为了明确流感大流行期间的肺部并发症，我们回顾了1999-2003年4个冬季因甲型流感住院的193名成人（≥ 18岁）的临床、实验室和影像学资料。平均年龄为75岁，8%有记录的细菌感染，15%需要重症监护室治疗，6%死亡。胸片（CXR）结果分为急性疾病（AD; n = 101）或无AD（NAD; n = 92）。大多数CXR发现本质上是微妙的。AD受试者更可能有>= 1个心脏病诊断（比值比[OR]，2.2 [95%置信区间{CI}，1.2-4.1]），检查时有罗音（OR，1.9 [95% CI，1.0-3.7]），有症状> 3天（OR，2.2 [ 95% CI，1.2-4.1]），不太可能发生喘息（OR，0.37 [95% CI，0.20-0.70]）。流感患者的总抗流感抗体滴度和中和抗流感抗体滴度低于呼吸道合胞病毒感染的对照受试者（P <0.05），这表明抗体具有保护作用。有趣的是，AD和NAD受试者之间的抗体滴度没有差异。在没有显著抗原变化的情况下，既往暴露于流感（包括接种疫苗）可能在降低流感相关下呼吸道疾病的严重程度方面发挥作用。
Background. To define the pulmonary complications of influenza during the current interpandemic period, we reviewed clinical, laboratory, and radiographic data from 193 adults (>= 18 years old) (1999-2003) who were hospitalized with influenza A during 4 winters.Results. The mean age was 75 years, 8% had documented bacterial infection, 15% required intensive care unit treatment, and 6% died. Chest radiograph (CXR) findings were classified as showing acute disease (AD; n = 101) or no AD (NAD; n = 92). Most CXR findings were subtle in nature. Subjects with AD were more likely to have >= 1 cardiac diagnosis (odds ratio [OR], 2.2 [95% confidence interval {CI}, 1.2-4.1]), to have rales on examination (OR, 1.9 [95% CI, 1.0-3.7]), to be symptomatic for > 3 days ( OR, 2.2 [ 95% CI, 1.2-4.1]), and to be less likely to wheeze (OR, 0.37 [95% CI, 0.20-0.70]). Total and neutralizing anti-influenza antibody titers were lower in patients with influenza than in respiratory syncytial virus-infected control subjects (P < .05), which suggests a protective effect of antibody. Interestingly, antibody titers did not differ between subjects with AD and those with NAD.Conclusion. In the absence of significant antigenic shifts, previous exposure to influenza, including vaccinations, may play a role in reducing the severity of influenza-associated lower respiratory tract disease.