【摘要】 目的探讨甲、乙型流感患者血细胞变化特点及其意义,对比磷酸奥司他韦对两者的治疗效果。方法回顾性研究2019年1～3月于北京积水潭医院感染疾病科通过咽拭子抗原检测确诊为甲、乙型流感的患者,采用抽签法随机选取确诊的甲型流感的患者共100例为甲型流感组,乙型流感的患者共69例为乙型流感组,收集分组的所有患者的临床资料。观察甲型流感和乙型流感患者的年龄分布,分析血常规与C反应蛋白(CRP)的变化及其临床意义,采用受试者工作特征曲线(ROC)分析白细胞计数、中性粒细胞百分比、淋巴细胞百分比、单核细胞百分比以及CRP对甲、乙型流感的诊断敏感性与特异度;通过对比两组患者全身症状缓解时间、发热持续时间、病毒核酸阳性时间来观察磷酸奥司他韦治疗效果。结果甲型流感各年龄段均有分布,以青少年、青年为重,乙型流感集中在中青年。与乙型流感比较,甲型流感患者的白细胞(6. 87±2. 08)×10~9/L、CRP(15. 96±3. 74) mg/L、中性粒细胞百分比(76. 29±7. 71)%明显升高,单核细胞百分比(9. 96±2. 67)%明显降低,差异均具有统计学意义(P <0. 05);但淋巴细胞百分比比较,差异无统计学意义(P>0. 05)。ROC曲线分析显示,白细胞计数、中性粒细胞百分比与CRP对甲、乙型流感具有鉴别诊断意义(ROC面积分别0. 665、0. 683、0. 713; P=0. 005、0. 004、0. 001)。经过磷酸奥司他韦治疗后,甲型流感患者在服药后全身症状恢复时间、发热持续时间均明显短于乙型流感患者,并且治疗前后比较其差异均具有明显的统计学意义(P <0. 05)。结论甲型流感以青少年、青年为主,乙型流感主要集中在中青年;甲型流感患者的白细胞计数、CRP及中性粒细胞明显升高,这三个指标对鉴别甲、乙型流感具有明显意义;磷酸奥司他韦对甲型流感的效果明显优于乙型流感,而且不良反应少。更多还原

【Abstract】 Objective To investigate the characteristics of blood cell change and its significance in influenza A and B patients and to observe the therapeutic effect of Oseltamivir phosphate on influenza A and B. Methods A retrospective study was conducted from January to March2019 in patients with influenza A and B confirmed by throat Swab Antigen Test in the Beijing Jishuitan Hospital,100 patients with influenza A and69 patients with influenza B were selected,and the clinical data of all patients were collected,the changes of blood routine and C-reactive protein( CRP) and their clinical significance were analyzed. The receiver operating characteristic( ROC) curve was used to analyze the sensitivity and specificity of white blood cell count,neutrophil percentage,lymphocyte percentage,monocyte percentage and CRP in diagnosing influenza A and B; the therapeutic effect of Oseltamivir phosphate was observed by comparing the remission time of symptoms,the duration of fever and the positive time of viral nucleic acid. Results Patients with influenza A were distributed in all age groups,mainly in adolescents and young people,while influenza B was mainly in young and middle-aged people. Compared with influenza B,white blood cell( 6. 87 ± 2. 08) × 10~9/L,CRP( 15. 96± 3. 74) mg/L and neutrophil percentage( 76. 29 ± 7. 71) % significantly increased in influenza A group( P < 0. 05),monocytes percentage( 9. 96 ± 2. 67) % significantly reduced( P < 0. 05),but there was no significant difference in lymphocyte percentage( P < 0. 05). The ROC curve analysis showed that white blood cell count,neutrophils percentage and CRP has a differential diagnostic significance for influenza A and B( area under the curve was 0. 665,0. 683,0. 713; P = 0. 005,0. 004,0. 001,respectively); after the treatment of Oseltamivir phosphate,the recovery time and duration of fever in influenza A patients were significantly shorter than those in influenza B patients,and the difference before and after treatment were statistically significant( P < 0. 05). Conclusion Influenza A is mainly in adolescents and young people,and influenza B is mainly in young and middle-aged people. The white blood cell count,CRP and neutrophils percentage of patients with influenza A are significantly increased,and these three indexes are of great significance in the differentiation of influenza A and B; Oseltamivir phosphate has a significantly better effect on influenza A than influenza B and has fewer adverse reactions.更多还原