Objective: To explore the clinical features and prognostic factors of parainfluenza viral lower respiratory tract infections in adults. Methods: A total of 70 patients withpositive nucleic acid of parainfluenza virus (PIV) admitted to China-Japan Friendship Hospital between August 2016 and November 2019 were enrolled. Multiplex real-time polymerase chain reaction (RT-PCR) assays for viral detection were implemented to specimens (nasopharynx swab, sputum or bronchoalveolar lavage) obtained from all the patients, which was consistent with the diagnosis of lower respiratory tract infection. Patients were divided into two groups depending on the status of immune function (immunocompromised group, n=26; immunocompetent group, n=44), and patients were divided into PIV infection group (n=43) and mixed infection group (n=27) according to whether there was mixed infection. Characteristics including age, gender, underlying diseases, symptoms, disease severity, imaging manifestations, etiology, respiratory failure, mechanical ventilation, vasoactive drug, antimicrobial drug and 30-day mortality between the groups were compared, and the prognostic factors of PIV infections were investigated using Cox regression. Results: The peak incidence of PIV infection time was in May, August, September and December, accounting for 58.6% of all cases. The enrolled 70 cases included 43 cases with pneumonia, 16 cases with interstitial lung disease and infection, 7 cases with bronchiectasis and infection, and 4 cases with acute exacerbation of chronic obstructive pulmonary disease. Eight patients (11.4%) had no underlying diseases, 21 patients (30.0%) had respiratory failure, 18 patients (25.7%) were treated with mechanical ventilation, 15 patients (21.4%) died within 30 days after admission. The pneumonia severity index score, percentage of patients with ground-glass opacity according CT scan, with honeycomb or reticular pattern, with mechanical ventilation, with respiratory failure, with ICU admission, and 30-day mortality in immunocompromised group were higher than those of immunocompetent group [(91.5 vs 84.0), (60.0% vs 34.1%), (44.0% vs 11.4%), (42.3% vs 15.9%), (50.0% vs 18.2%), (38.5% vs 22.7%), (34.6% vs 13.6%)] (all P<0.05). There were 27 cases (38.6%) with mixed infection, including 17 viruses (24.3%), 19 bacteria (27.1%), 14 (20.0%) fungi (PCP, aspergillus) and 1 (1.4%) Mycobacterium intracellulare. Sixteen patients (59.3%) in the mixed infection group were immunocompromised patients and 21 patients (77.8%) had chronic lung disease. Cox regression analysis showed that mechanical ventilation and interstitial lung disease were independent predictors of prognosis in all patients, and mechanical ventilation was an independent predictor of prognosis in PIV infection group. Conclusions: Most of the patients with PIV lower respiratory tract infection in adults are complicated with underlying diseases and mixed infection, with a high 30-day mortality. Interstitial lung disease and mechanical ventilation indicate poor prognosis in these patients.
目的： 分析成人副流感病毒（PIV）下呼吸道感染患者的临床特征及预后。 方法： 以2016年8月至2019年11月入住中日友好医院呼吸科或重症监护病房（ICU）的PIV核酸阳性患者70例为研究对象，患者均行鼻咽拭子、痰或支气管肺泡灌洗液（BALF）检查，且符合下呼吸道感染的诊断，根据是否合并免疫功能低下，分为免疫功能正常组（44例）和免疫功能低下组（26例），根据是否合并混合感染，分为单纯PIV感染组和混合感染组。对两组患者的年龄、性别、基础疾病、症状、疾病严重程度、影像学表现、病原学特征、是否合并呼吸衰竭、机械通气、是否应用血管活性药物、抗菌药物应用情况、30 d病死率等情况等进行比较分析，并应用Cox回归分析探讨PIV下呼吸道感染患者的预后因素。 结果： 4月份、7~8月份和12月份是PIV发病高峰，占所有患者的58.6%（41/70）。70例患者包括肺炎43例（61.4%），间质性肺疾病合并感染16例（22.9%），支气管扩张合并感染7例（10%），慢性阻塞性肺疾病急性加重4例（5.7%）。8例（11.4%）患者没有任何基础疾病，21例（30.0%）合并呼吸衰竭，18例（25.7%）给予机械通气治疗，15例（21.4%）30 d内死亡。免疫功能低下组患者肺炎严重指数评分，CT合并磨玻璃影和网格、蜂窝影的比例，机械通气、呼吸衰竭、住ICU的比例及30 d病死率均显著高于免疫功能正常组[（91.5分比84.0分）、（60.0%比34.1%）、（44.0%比11.4%）、（42.3%比15.9%）、（50.0%比18.2%）、（38.5%比22.7%）、（34.6%比13.6%）]（均P<0.05）；PIV下呼吸道感染中合并混合感染27例（38.6%），其中病毒检出17株（24.3%），细菌19株（27.1%），真菌（曲霉）14株（20.0%），胞内分枝杆菌1株（1.4%）。混合感染组中16例（59.3%）患者合并免疫功能低下，21例（77.8%）患者合并基础肺疾病。Cox回归分析发现机械通气和间质性肺疾病为PIV下呼吸道感染患者预后的独立预测因子，机械通气为单纯PIV感染患者预后的独立预测因子。 结论： 成人PIV下呼吸道感染患者多合并基础疾病，且易合并混合感染，30 d病死率高，若合并间质性肺疾病或机械通气提示预后不佳。.
Keywords: Disease attributes; Parainfluenza virus; Prognosis; Respiratory tract infections.