摘要目的:分析重症流感患者的临床特点及预后危险因素。方法:回顾性分析2014年3月至2019年6月安徽医科大学第二附属医院呼吸与危重症医学科收治的重症流感患者的临床资料，根据住院结局及28 d随访结果分析生存组与死亡组患者的一般资料、实验室检查结果、病原学检查结果等，并采用Logistic回归分析预后相关因素。结果:37例患者中男性29例，女性8例；年龄25～86岁，平均（59.59±15.16）岁；21例合并慢性基础疾病；合并病原菌感染的28例患者中细菌感染6例，真菌感染7例，其他病原菌感染3例，混合感染12例。37例患者中，住院期间死亡9例，出院28 d死亡5例，总病死率为37.84%。与生存组比较，死亡组患者年龄更大（岁：66.57±13.94比55.35±14.53），英国胸科协会改良肺炎评分（CURB-65评分）、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、中性粒细胞计数、D -二聚体、48 h C -反应蛋白（CRP）和降钙素原（PCT）更高〔CURB-65评分（分）：2（2，3）比1（0，2），APACHEⅡ（分）：16.00±4.62比11.00±4.22，中性粒细胞计数（×10 9/L）：8.87（5.42，11.33）比3.58（2.55，7.13），D -二聚体（mg/L）：7.97（5.19，12.68）比2.91（1.19，5.02），48 h CRP（mg/L）：127.83±92.24比87.01±57.00，48 h PCT（μg/L）：1.79（0.59，4.44）比0.37（0.13，0.99）〕，氧合指数（PaO 2/FiO 2）、肌酐清除率更低〔PaO 2/FiO 2（mmHg，1 mmHg＝0.133 kPa）：109.52±49.30比204.82±67.61，肌酐清除率（mL·min -1·1.73 m -2）：55.49±21.23比77.59±29.73〕，差异均有统计学意义（均 P<0.05）；而两组性别、合并慢性基础疾病、淋巴细胞计数、白蛋白、乳酸脱氢酶（LDH）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、24 h CRP和PCT差异均无统计学意义。共培养出37株病原菌，其中革兰阴性菌17株（45.95%），革兰阳性菌3株（8.10%），真菌17株（45.95%）。死亡组鲍曼不动杆菌感染例数显著多于生存组（例：7比2， P<0.05）。Logistic回归分析显示，年龄、CURB-65评分、APACHEⅡ评分、PaO 2/FiO 2、中性粒细胞计数、肌酐清除率、合并鲍曼不动杆菌感染以及住院期间深静脉置管、留置尿管、保留胃管均为重症流感患者预后危险因素〔风险比（ HR）分别为1.064、4.920、1.286、0.975、1.286、0.965、0.095、0.083、9.333、0.089，均 P<0.05〕。多因素分析显示，低PaO 2/FiO 2和合并鲍曼不动杆菌感染是重症流感预后不良的危险因素（ HR值分别为0.834、0.000，均 P<0.05）。 结论:高龄、高CURB-65评分、高APACHEⅡ评分、合并感染均为重症流感患者预后不良的危险因素。

abstractsObjective:To explore the clinical characteristics and prognostic risk factors of severe influenza.Methods:Clinical data of severe influenza patients admitted to the department of respiratory and critical care medicine of the Second Affiliated Hospital of Anhui Medical University from March 2014 to June 2019 were retrospectively analyzed. General information, laboratory test results, and etiological test results of the hospitalization outcomes for survival group and death group during the 28-day follow-up were analyzed using Logistic regression analysis.Results:Among the 37 patients, 29 were males and 8 were females. They aged 25-86 years old with an average of (59.59±15.16) years old. Twenty-one cases had chronic underlying diseases; 28 cases had co-infections, including 6 cases with bacterial infections, 7 cases with fungal infections, 3 case with other pathogens, and 12 cases with mixed infection. Among the 37 patients, 9 died during hospitalization and 5 died within 28-day of discharge. The overall mortality rate was 37.84%. Compared with the survival group, patients in the death group were older (years old: 66.57±3.94 vs. 55.35±14.53), British Thoracic Society's modified pneumonia score (CURB-65 score), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, neutrophil count, D-dimer, 48-hour C-reactive protein (CRP) and procalcitonin (PCT) were higher [CURB-65 score: 2 (2, 3) vs. 1 (0, 2), APACHEⅡ: 16.00±4.62 vs. 11.00±4.22, neutrophil count (×10 9/L): 8.87 (5.42, 11.33) vs. 3.58 (2.55, 7.13), D-dimer (mg/L): 7.97 (5.19, 12.68) vs. 2.91 (1.19, 5.02), 48-hour CRP (mg/L): 127.83±92.24 vs. 87.01±57.00, 48-hour PCT (μg/L): 1.79 (0.59, 4.44) vs. 0.37 (0.13, 0.99)], oxygenation index (PaO 2/FiO 2) and creatinine clearance rate were lower [PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 109.52±49.30 vs. 204.82±67.61, creatinine clearance rate (mL·min -1·1.73 m -2): 55.49±21.23 vs. 77.59±29.73], and the differences were statistically significant (all P < 0.05). There was no significant difference in gender, combined chronic underlying diseases, lymphocyte count, albumin, lactate dehydrogenase (LDH), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), 24-hour CRP and PCT between the two groups. A total of 37 pathogens were cultured, including 17 Gram-negative bacteria (45.95%), 3 Gram-positive bacteria (8.10%), and 17 fungi (45.95%). The number of Acinetobacter baumannii infections in the death group was significantly higher than that in the survival group (cases: 7 vs. 2, P < 0.05). Logistic regression analysis showed that age, CURB-65 score, APACHEⅡ score, PaO 2/FiO 2, neutrophil count, creatinine clearance rate, combined Acinetobacter baumannii infection, deep vein catheterization, catheterization, and stomach preservation during hospitalization were risk factors for the prognosis of patients with severe influenza [hazard ratios ( HR) were 1.064, 4.920, 1.286, 0.975, 1.286, 0.965, 0.095, 0.083, 9.333, 0.089, respectively, all P < 0.05]. Multivariate analysis showed that low PaO 2/FiO 2 and Acinetobacter baumannii infection were risk factors for prognosis of severe influenza ( HR were 0.834 and 0.000, respectively, both P < 0.05). Conclusion:Old age, high CURB-65 score, high APACHEⅡ score, and co-infection are risk factors for the prognosis of patients with severe influenza.