趋势线画法分析.ppt

文档介绍：社区获得性肺炎的新认知
复旦大学附属中山医院
复旦大学呼吸病研究所
何礼贤
甲型H1N1流感流行使CAP临床诊治面临新的挑战
CAP病原学诊断困难赋予经验性治疗更沉重的责任
推行体现CAP规范化诊治的临床路径时需要特别重视个体化的处理
2009年,H1N1流感及季节性流感成为全球关注的热点
截至2009年11月20日,全球H1N1的死亡人数已超过7800人(CDC)阿根廷甲流患者死亡率要高于世界其它地区(%%), 哥伦比亚大学Palacios报告,合并细菌的混合感染可能为导致这一现象的主要原因
Cioti SK et al. Biosecuricy and Bioterrorism: Biodefc:nse Strategy. Practice. 2009 .7(3.); 311-316.
Gustavo Palacios et al. PLoS ONE,2009; 4(12): e8540.
据新华网:2010-01-09 WHO报告全球H1N1流感死亡至少12799人;
2010-02-25 中国卫生部统计全国死于H1N1流感775例
The young are disproportionately affected
Attack rate highest in children 5-14 years (147/100K), 14 times higher than adults aged ≥ 60
Overall case-fatality rates similar to seasonal flu so far
MMWR 2009, 58(33);913-918
Case-fatality proportion by age
JAMA 2009, 302(17);1896-1902
Factors associated with hospitalization and death
60% of children and 72% of adults had underlying conditions
Of 268 adults with known BMI, 58% were BMI≥30 and 43% were BMI≥40
The median time from onset of symptoms to hospitalization was 2 days (0-31 days)
31% admitted to ICU
51% received antiviral within 48 hours
4% had secondary bacterial infection
11% died
JAMA, 2009;302(17):1896-1902
病毒感染通常合并细菌性肺炎,据报道约25%的流感患者最终死于继发性细菌感染1
Morens等学者回顾性分析1918年流感中58个患者的肺组织和8000个尸检资料发现:患者肺泡中性粒细胞浸润+ 大于95%的肺组织中检出细菌


结论:患者死亡因素主要是继发性呼吸道细菌感染2
主要致病菌为:金葡球菌、肺炎链球菌、流感嗜血杆菌
病毒继发细菌的混合感染是患者死亡的真正原因
L et al. ine 1999;17(Suppl I):S3·SI0.
7. Levandowski RA et Lab Clin Mtd 1985:106:428-432.
合并肺炎链球菌肺炎是1918年流感患者死亡的重要原因
流感相关性肺炎和肺炎链球菌肺炎患病到死亡时间分布相似
9、Klugman KP, et al. Emerg Infect Dis 2009,15(2):346-347.