Analysis of influencing factors of severe influenza B virus pneumonia complicated with invasive pulmonary aspergillosis

doi:10.11958/20251154

Abstract

Abstract:

Objective To investigate the clinical characteristics and risk factors of severe influenza B viral pneumonia complicated with invasive pulmonary aspergillosis. Methods Forty-six patients with severe influenza B virus pneumonia were collected and divided into the invasive pulmonary aspergillosis (IPA) group (17 cases) and the control group (29 cases) based on whether they were complicated with IPA. The clinical manifestations, laboratory indicators, chest CT imaging findings, bronchoscopic manifestations, broncho alveolar lavage fluid (BALF) culture and metagenomic next-generation sequencing results were compared between the two group. Treatment conditions and final treatment outcomes were also compared between the two groups. Univariate and multivariate Logistic regression analyses were conducted to explore risk factors of severe influenza B virus pneumonia complicated with IPA. Results After treatment, a total of 6 patients died (35.30%), all of whom were in the invasive pulmonary aspergillosis group. In both groups, the symptoms of dyspnea, cough, expectoration and chest pain were more severe, and systemic symptoms such as fatigue, fever and muscle pain were also quite obvious. There were no significant differences in clinical symptoms, combined bacterial infection and hormone use between the two groups. Compared with the control group, white blood cell count, neutrophil count, blood GM test and BALF GM test were higher in the combined group. The proportion of patients with nodules and patchy shadows on imaging and the proportion of patients showing pseudomembrane manifestations under bronchoscopy were higher (P<0.05). Univariate Logistic regression analysis showed that white blood cell count, GM in BALF, nodules and patchy shadows in lung imaging and pseudomembrane manifestations under bronchoscopy were influencing factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis (P<0.05). Multivariate Logistic regression analysis showed that GM ≥ 1 in BALF and pseudomembrane manifestations under bronchoscopy were risk factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis (P<0.05). Conclusion When GM test level of BALF in patients with severe influenza B virus pneumonia is ≥1 and pseudomembrane manifestations are seen under bronchoscopy, the possibility of combined invasive pulmonary aspergillus infection should be highly vigilant.

Key words: influenza B virus, pneumonia, viralviral, invasive pulmonary aspergillosis, bronchoscopes, galactomannan test

CLC Number:

R563.1

Figures/Tables 7

References 19

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组别	n	性别（男/女）	年龄/岁	2型糖尿病
对照组	29	17/12	50.69±20.60	2（6.90）
合并组	17	10/7	51.12±21.03	4（23.53）
t或χ2		0.000	0.068	1.353
组别	慢性阻塞性肺疾病	恶性肿瘤	心血管疾病	免疫性疾病
对照组	2（6.90）	1（3.45）	4（13.79）	1（3.45）
合并组	2（11.76）	2（11.76）	1（5.88）	0（0）
χ2或P	0.001	0.234	0.117	1.000^▲

组别	n	性别（男/女）	年龄/岁	2型糖尿病
对照组	29	17/12	50.69±20.60	2（6.90）
合并组	17	10/7	51.12±21.03	4（23.53）
t或χ2		0.000	0.068	1.353
组别	慢性阻塞性肺疾病	恶性肿瘤	心血管疾病	免疫性疾病
对照组	2（6.90）	1（3.45）	4（13.79）	1（3.45）
合并组	2（11.76）	2（11.76）	1（5.88）	0（0）
χ2或P	0.001	0.234	0.117	1.000^▲

组别	n			呼吸困难		咳嗽			胸痛			咯血
对照组	29			16（55.17）		29（100.00）			16（55.17）			5（17.24）
合并组	17			12（70.59）		14（82.35）			6（35.29）			2（11.76）
χ2				1.069		2.963			1.697			0.005
组别			咳痰		乏力			发热		肌肉酸痛
对照组			25（86.21）		24（82.76）			27（93.10）		19（65.52）
合并组			10（58.82）		11（64.71）			16（94.12）		9（52.94）
χ2			3.040		1.056			0.000		0.712
组别		合并细菌感染					经验性抗真菌治疗				使用激素
对照组		14（44.83）					10（34.49）				2（6.90）
合并组		10（58.82）					14（82.35）				5（29.41）
χ2		0.478					9.842^＊＊				2.647

组别	n			呼吸困难		咳嗽			胸痛			咯血
对照组	29			16（55.17）		29（100.00）			16（55.17）			5（17.24）
合并组	17			12（70.59）		14（82.35）			6（35.29）			2（11.76）
χ2				1.069		2.963			1.697			0.005
组别			咳痰		乏力			发热		肌肉酸痛
对照组			25（86.21）		24（82.76）			27（93.10）		19（65.52）
合并组			10（58.82）		11（64.71）			16（94.12）		9（52.94）
χ2			3.040		1.056			0.000		0.712
组别		合并细菌感染					经验性抗真菌治疗				使用激素
对照组		14（44.83）					10（34.49）				2（6.90）
合并组		10（58.82）					14（82.35）				5（29.41）
χ2		0.478					9.842^＊＊				2.647

组别			n	WBC/ （×10⁹/L）		NEU/ （×10⁹/L）			LYM/ （×10⁹/L）
对照组			29	9.79±3.00		8.67±2.97			0.70（0.55，0.80）
合并组			17	12.65±4.20		11.58±4.21			0.52（0.36，0.69）
t或Z				2.689^＊		2.750^＊＊			1.840
组别	CRP/（mg/L）						PCT/（μg/L）			IL-6/（ng/L）
对照组	55.40（23.50，77.15）						0.74（0.14，1.30）			56.80（25.60，92.10）
合并组	68.70（34.05，122.23）						0.38（0.22，1.27）			46.90（17.79，63.23）
Z	1.252						0.364			1.104
组别		血GM 试验			BALF GM 试验			ALB/ （g/L）			APACHEⅡ 评分/分
对照组		0.56（0.31，0.75）			0.75（0.52，0.95）			32.53±3.22			9.07±3.00
合并组		1.40（0.28，2.35）			3.60（2.40，4.70）			30.99±3.40			11.35±4.36
t或Z		2.026^＊			5.260^＊＊			1.538			1.912