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| 流行性感冒住院患者抗病毒治疗及结局 |
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| Antiviral Therapy and Outcomes in Hospitalized Patients with Influenza |
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| Chan-Tack KM, Murray JS 2009/5/27 10:49:52 |
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| Clin Infect Dis, 2008, |
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| View at Publisher |
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Abstract
Background:
Numerous challenges exist in trying to design a study of patients hospitalized with influenza. Among these are defining the patient population, determining the primary study end point, designing the study, and evaluating efficacy. A large, prospective cohort of patients in the hospital with laboratory-confirmed influenza was studied for the effect of antiviral therapy on their outcomes.
Design and Limitations:
The 541 patients were all hospitalized in institutions participating in the Toronto Invasive Bacterial Diseases Network. The design was observational. Limitations include the design, the size of the sample, the diagnostic methods, the lack of comparison of antiviral treatment effects in various subgroups, insufficient power to measure the effect of time to first treatment, with respect to symptoms, the inability to generalize the findings, and potential confounding variables, including a bias created by lack of randomization. The theory being tested was that antiviral treatment of hospitalized patients with influenza can reduce mortality. The end point was mortality within 15 days of symptom onset.
Results:
The study corroborates others that report substantial morbidity and mortality related to influenza. However, antiviral agents may not have been given to patients with prolonged duration of symptoms, poor gastrointestinal absorption, or other situations that were perceived to suggest a low likelihood of benefit. The study population was not randomized and was insufficient to adequately distinguish the efficacy differences between those who received antiviral agents and those who did not. Currently, no evidence-based standard of care exists for treating patients in the hospital with influenza. When the patient entered the study, with respect to the onset of symptoms, was also problematic. Giving antivirals more than 48 hours after the onset of symptoms has not been studied in a randomized, controlled format. The effect of existing drugs that the patients may have been using was also omitted. The choice of end point was not necessarily the most appropriate one, and no surrogate marker has been able to predict clinical outcome. A combined end point may be needed and should be based on evidence from other studies.
Conclusions:
Even with all the limitations, the study showed that it is possible to conduct studies of patients hospitalized with influenza. The sample size, in the hundreds, was sufficient to detect differences in some clinical end points. Some data suggest that patients with severe influenza may have prolonged viral replication, making antiviral medications efficacious, even if given more than 48 hours after symptom onset. Randomized prospective studies are needed to determine the best role for antivirals in these patients.
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 疾病资源中心
病例分析 [栏目介绍]
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
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