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中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 361 -367. doi: 10.3877/cma.j.issn.1674-1358.2021.06.001

流感专题

北京地区孕妇流行性感冒临床特征及危重症影响因素
赵雪1, 钱芳2, 宋美华2, 韩冰2, 陈美玲3, 王蓓蓓3, 宋蕊1,()   
  1. 1. 100015 北京,北京大学北京地坛医院教学医院;100015 北京,首都医科大学附属北京地坛医院感染性疾病诊治与研究中心
    2. 100015 北京,首都医科大学附属北京地坛医院感染性疾病诊治与研究中心
    3. 100015 北京,北京大学北京地坛医院教学医院
  • 收稿日期:2021-03-20 出版日期:2021-12-15
  • 通信作者: 宋蕊
  • 基金资助:
    2020年北京市医管中心"扬帆计划"(No. XMLX202149); 首都医科大学附属北京地坛医院院内基金(No. DTZLX201709)

Clinical characteristics and analysis of prognostic factors of influenza in pregnant women in Beijing

Xue Zhao1, Fang Qian2, Meihua Song2, Bing Han2, Meiling Chen3, Beibei Wang3, Rui Song1,()   

  1. 1. Peking University Ditan Teaching Hospital, Beijing 100015, China; The National Clinical Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
    2. The National Clinical Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
    3. Peking University Ditan Teaching Hospital, Beijing 100015, China
  • Received:2021-03-20 Published:2021-12-15
  • Corresponding author: Rui Song
引用本文:

赵雪, 钱芳, 宋美华, 韩冰, 陈美玲, 王蓓蓓, 宋蕊. 北京地区孕妇流行性感冒临床特征及危重症影响因素[J/OL]. 中华实验和临床感染病杂志(电子版), 2021, 15(06): 361-367.

Xue Zhao, Fang Qian, Meihua Song, Bing Han, Meiling Chen, Beibei Wang, Rui Song. Clinical characteristics and analysis of prognostic factors of influenza in pregnant women in Beijing[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(06): 361-367.

目的

分析流行性感冒(流感)季节中重症流感孕妇的人口学特征、病原学特征及预后,并探讨与流感危重症相关的影响因素。

方法

收集首都医科大学附属北京地坛医院2013年8月至2020年5月收治的实验室确诊流感孕产妇的流行病学和临床信息进行回顾性研究。对患者一般资料、流行病学、临床表现及体征进行描述性统计并观察其临床结局:是否危重症、住院时间和胎儿预后。根据患者住院进展分为重症组(72例)和危重症组(7例)。

结果

共有79例孕妇患者确诊为重症流感。孕妇年龄20~40岁,中位年龄为31岁,疫苗接种率为0%。本研究中孕妇流感患者在所有妊娠期均有发生,但住院患者大多处于妊娠晚期(64/79、82.29%)。重症组和危重症组孕产妇孕期(P = 0.023)和听诊闻及干湿性啰音比例(P = 0.019)差异有统计学意义(Fisher’s确切概率法)。高龄(Z =-3.096、P = 0.002)和危重症(Z =-2.64、P = 0.008)均为流感孕产妇住院时间的影响因素。入组患者中21例(26.58%)孕妇足月生产,6例(7.59%)孕妇早产,7例(8.86%)孕妇流产,45例(56.96%)孕妇患者维持妊娠状态。Logistic回归分析显示危重症患者相对于重症患者出现干/湿啰音体征的风险增加(OR = 7.69、95%CI:1.19~49.85、P = 0.019)。

结论

住院孕产妇流感患者中以晚期妊娠最为多见,流感孕妇患者病程早期入院疗效良好,早中期妊娠孕妇患流感后对胎儿和新生儿的不良影响更为显著。

Objective

To investigate the demographic characteristics, etiological characteristics and clinical prognosis of pregnant women with severe influenza, and to explore the influencing factors associated with clinical severity.

Methods

The epidemiological and clinical information of pregnant women with influenza who were confirmed by laboratory tests in Beijing Ditan Hospital, Capital Medical University from August 2013 to May 2020 were analyzed, retrospectively. Descriptive statistics were performed on general condition, epidemiology, clinical manifestations and signs of the patients, and clinical outcomes were observed: critical illness, hospitalized duration and fetal prognosis. According to the progress after hospitalization, patients were divided into severe group (72 cases) and critical group (7 cases).

Results

Total of 79 pregnant women were diagnosed with severe influenza. The age of 79 cases ranged from 20 to 40 years old, with a median age of 31 years old. None of the patients was vaccinated. Influenza virus infection occurred in all trimesters, but the majority of hospitalized patients were in the third trimester (64/79, 82.29%). Pregnancy stage (P = 0.023), auscultation with dry and wet pulmonary rale on admission (P = 0.019) of pregnant women in severe and critically ill groups were significantly different (Fisher’s exact test). Older age (Z =-3.096, P = 0.002) and critical illness (Z =-2.64, P = 0.008) were both influencing factors for the hospitalized duration of pregnant women with influenza. Total of 45 cases remained pregnant, 7 cases miscarried, 6 babies delivered preterm, and 21 babies delivered to term. Univariable Logistic regression analysis showed that the risk of dry/wet rales of cases with critically illness increased compared with that of severe cases (OR = 7.69, 95%CI: 1.19-49.85, P = 0.019).

Conclusions

Among the hospitalized maternal patients with influenza infection, the third trimester is the most common. For pregnant women with influenza, early hospitalization yields good results. The adverse effects of influenza for pregnant women during the first and second trimesters on fetuses and newborns are more obvious.

表1 流感孕产妇年龄、孕期、基础疾病以及病原学特征[例(%)]
表2 流感孕产妇症状、体征及抗病毒治疗[例(%)]
表3 79例流感孕产妇的住院时间
表4 79例住院流感孕妇出院时妊娠结局[例(%)]
表5 64例晚期妊娠孕妇出院时妊娠结局[例(%)]
表6 流感孕产妇发生危重症影响因素的Logistic回归分析
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