Analysis on influencing factors of clinical features and prognosis of acute sepsis type of melioidosis
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摘要: 目的 观察急性脓毒症型类鼻疽的临床特征，并针对性分析其预后的影响因素。方法 选取2018年1月—2021年1月期间我院收治的80例急性脓毒症型类鼻疽患者作为研究对象，观察记录所有患者的临床特征，并记录所有患者的预后(病死)情况，根据预后情况分为不良组与良好组，设计基线资料统计表，详细统计两组患者的基线资料，分析急性脓毒症型类鼻疽预后的影响因素。结果 全部患者均有畏寒、发热，另有咳嗽、咳痰，胸闷气促等主要临床症状，主要体征有肺部啰音、皮肤脓肿、肝脾肿大；80例急性脓毒症型类鼻疽患者经治疗后病死26例，病死率为32.50%(26/80)，纳入不良组；54例存活，存活率为67.50%(54/80)，纳入良好组；不良组与良好组患者的出现症状至接受治疗时间、治疗方法、用药疗程比较差异有统计学意义(P< 0.05)，组间其他资料比较差异无统计学意义(P>0.05)；经Cox回归分析结果显示，年龄大、出现症状至接受治疗时间长是急性脓毒症型类鼻疽患者预后不良的影响因素(HR>1，P< 0.05)，用药疗程长是急性脓毒症型类鼻疽患者预后不良的保护因素(HR< 1，P< 0.05)。结论 急性脓毒症型类鼻疽主要临床特征较为复杂，预后不良风险较高，其中年龄大、出现症状至接受治疗时间长，用药疗程短可能是患者预后不良的影响因素。Abstract: Objective To observe the clinical features of acute sepsis type of melioidosis, and target analyze the influencing factors of its prognosis.Methods Eighty patients patients with acute sepsis type of melioidosis treated in our hospital from January 2018 to January 2021 were selected as the research subjects. The clinical characteristics of all patients were observed and recorded, and the prognosis (death from illness) of all patients was recorded. According to the prognosis, they were divided into the poor group and the good group. The statistical table of baseline data was designed. The baseline data of patients in the two groups was counted in detail. The influencing factors of prognosis of acute sepsis type of melioidosis were analyzed and found out.Results All patients had the main clinical features of chills, fever, cough, expectoration, chest tightness and shortness of breath. The main signs were pulmonary rales, skin abscess, hepatosplenomegaly. Among 80 patients with acute sepsis type of melioidosis, after treatment, 26 died, with a mortality of 32.50% (26/80), were included in the poor group; 54 survived, with a survival rate of 67.50% (54/80), were included in the good group. Compare the time from symptom occurance to treatment, treatment method and course of treatment of patients in the good group and the poor group, the difference was statistically significant (P< 0.05). There was no statistically significant difference in other data between the two groups (P>0.05). The results of Cox regression analysis showed that older age and longer time from symptom occurance to treatment were the influencing factors of poor prognosis in patients with acute sepsis type of melioidosis (HR>1,P>0.05), long course of medication was a protective factor for poor prognosis of patients with acute sepsis type of melioidosis (HR< 1,P< 0.05).Conclusion The main clinical features of acute sepsis type of melioidosis are complicated, and the risk of poor prognosis is high. Older age, longer time from symptom occurance to treatment and shorter course of treatment may be the influencing factors of poor prognosis.
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Key words:
- melioidosis /
- sepsis /
- clinical features /
- prognosis /
- influencing factor
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表 1 急性脓毒症型类鼻疽的临床特征
临床特征 例数 占比/% 症状 畏寒、发热 80 100.00 乏力、食欲不振 52 65.00 咳嗽、咳痰 75 93.75 胸闷、气促 72 90.00 心悸、胸痛 58 72.50 头痛、呕吐、昏迷 39 48.75 腹泻、腹痛 27 33.75 腰痛、血尿 35 43.75 体征 肺部啰音 79 98.75 休克、DIC 25 31.25 皮肤脓肿 78 97.50 肝脾肿大 76 95.00 颈抵抗 42 52.50 脑膜刺激征 29 36.25 皮肤出血点 58 72.50 
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表 2 不良组与良好组患者的基线资料比较
例(%)，X±S 基线资料 不良组(26例) 良好组(54例) χ2/t P 性别 男 18(69.23) 36(66.67) 0.053 0.819 女 8(30.77) 18(33.33) 年龄/岁 57.32±3.65 53.69±4.28 3.924 < 0.001 职业 农民 9(34.62) 21(38.89) 渔民 8(30.77) 20(37.04) 0.436a) 0.933 海事工作者 5(19.23) 8(14.81) 其他 2(7.69) 5(9.26) 合并糖尿病 是 3(11.54) 10(17.86) 0.220a) 0.639 否 23(88.46) 44(81.48) 合并高血压 是 5(19.23) 13(24.07) 0.236 0.627 否 21(80.77) 41(75.93) 肺结核 有 4(15.38) 9(16.67) 0.032a) 0.859 无 22(84.62) 45(83.33) 出现症状至接受治疗时间/d 17.32±3.20 12.10±2.28 8.377 < 0.001 治疗方法 单药治疗 14(53.85) 16(29.63) 4.391 0.036 多药联合治疗 12(46.15) 38(70.37) 合并低蛋白血症 是 5(19.23) 10(18.52) 0.053a) 0.819 否 21(80.77) 44(81.48) 用药疗程/周 5.62±1.03 7.24±1.35 5.402 < 0.001 注：a)采用连续校正χ2检验。
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表 3 自变量赋值情况
自变量 变量情况 赋值情况 年龄 连续变量 - 出现症状至接受治疗时间 连续变量 - 治疗方法 分类变量 1=“单药治疗”，
0=“多药联合治疗”用药疗程 连续变量 -
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表 4 急性脓毒症型类鼻疽患者预后影响因素的Cox分析结果
影响因素 B SE Wald P HR 95%CI 年龄 0.186 0.053 12.572 < 0.001 1.205 1.087~1.335 出现症状至接受治疗时间 0.374 0.063 34.967 < 0.001 1.453 1.284~1.645 治疗方法 0.742 0.437 2.888 0.089 2.101 0.892~4.947 用药疗程 -0.575 0.121 22.524 < 0.001 0.563 0.444~0.713
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