Antibiotic sensitivity of pneumonia pathogens in newborns and problems of antibacterial therapy of the pathologic process]

The results of the bacteriological investigation of the secretion from the trachea, large bronchi and fauces of 36 newborns (including 27 preterms) with severe pneumonia were analyzed. 20 of them were born of women with complicating somatic, obstetric and gynecologic histories: candidiasis, herpes genitalis, chronic endometritis, adnexitis or chronic pyelonephritis that could be the risk of the fetus intranatal infection. During the acute period of pneumonia in the newborns within the first 4-8 days of life mainly Pseudomonas aeruginosa was isolated (51.3 per cent), Staphylococcus epidermidis, S. haemolyticus and Enterococcus faecalis were less frequent (18.9, 8.1 and 5.4 per cent, respectively). Klebsiella pneumoniae, Streptococcus anhaemolyticus and other organisms were extremely rare. On the whole the gramnegative microflora predominated. The study of the antibiotic susceptibility showed that the majority of the P. aeruginosa isolates were susceptible to amikacin and polymyxin B, the isolates susceptible to ceftazidime were less frequent, 20-25 per cent of the isolates were susceptible to ciprofloxacin, cefoperazone and imipenem and practically no isolates were susceptible to gentamicin. The S.epidermidis isolates were susceptible to rifampicin and vancomycin and in rare cases to fusidin and amikacin and resistant to oxacillin. When the treatment course was more than 15 days, the isolates proved to be susceptible to 1/3 of the presently available antibiotics. Because of the host low protective forces, peculiarities of the infection pathways and high frequency of the resistant strains it is valid to include netilmicin, imipenem, cefoperazone and ceftriaxone to the complex therapy of the newborns along with the substitution immunotherapy.     

A 21-Day of Adjunctive Corticosteroid Use May Not Be Necessary for HIV-1-Infected Pneumocystis Pneumonia with Moderate and Severe Disease

Background

The current guidelines recommend 21-day adjunctive corticosteroid therapy for HIV-1-infected pneumocystis pneumonia patients (HIV-PCP) with moderate-to-severe disease. Whether shorter adjunctive corticosteroid therapy is feasible in such patients is unknown.

Methods

We conducted a retrospective study to elucidate the proportion of patients with moderate and severe HIV-PCP who required adjunctive corticosteroid therapy for 21 days. The enrollment criteria included HIV-PCP that fulfilled the current criteria for 21-day corticosteroid therapy; PaO₂ on room air of <70mmHg or A-aDO₂ ≥35 mmHg.

Results

The median duration of corticosteroid therapy in the 73 study patients was 13 days (IQR 9–21). Adjunctive corticosteroid therapy was effective and discontinued within 10 and 14 days in 30% and 60% of the patients, respectively. Only 9% of the patients with moderate HIV-PCP (n = 22, A-aDO₂ 35–45 mmHg) received steroids for >14 days, whereas 35% of the patients with severe HIV-PCP (n = 51, A-aDO₂ ≥45 mmHg) required corticosteroid therapy for ≥21 days. Four (13%) of the severe cases died, whereas no patient with moderate disease died. Among patients with severe HIV-PCP, discontinuation of corticosteroid therapy within 14 days correlated significantly with higher baseline CD4 (p = 0.049).

Conclusion

Shorter adjunctive corticosteroid therapy was clinically effective and adjunctive corticosteroid could be discontinued within 14 days in 60% of moderate-to-severe HIV-PCP and 90% of moderate cases.     

Therapeutic experience with netilmicin.

Netilmicin, a new aminoglycoside antibiotic, was used to treat 19 patients with urinary tract infection and 5 with systemic infection. The causal organisms were Escherichia coli (in 2), Klebsiella pneumoniae (in 4), Serratia marcescens (in 12) and Pseudomonas aeruginosa (in 7); 1 patient was infected with two of these organisms. All the isolates of causal organisms except one of Serratia were initially sensitive to netilmicin but many were resistant to other aminoglycosides. Sixteen of the urinary tract infections responded to netilmicin therapy, although relapse occurred in three patients. Two of the three patients with musculoskeletal infection responded to combined therapy with surgery and netilmicin; the other patient responded to the same regimen but with carbenicillin added. Netilmicin cured pneumonia in one patient but failed in the other patient with pneumonia, who had leukemia. Superinfection occurred in five patients with urinary tract infection. Adverse reactions to netilmicin were minor. Netilmicin may prove to be a useful agent, particularly for infections due to multiresistant Klebsiella or Serratia, or when prolonged aminoglycoside therapy is required.     

Burden of Severe Pneumonia,Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3–3.9 million) episodes of severe pneumonia and 0.35 million (0.31–0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49–0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92–119 thousand) pneumococcal deaths occurred in India. The top contributors to India’s pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results highlight the need to improve access to care and increase coverage and equity of pneumonia preventing vaccines in states with high pneumonia burden.     

Elective delivery and the neonatal respiratory distress syndrome.

A prospective study was carried out to determine how often moderate or severe respiratory distress syndrome in infants delivered electively after 32 weeks'' gestation or more is avoidable. During a 9-month period 64 such newborns were evaluated. The disease was considered avoidable in 14 (22%) since the indication for elective delivery was questionable. The mean birth weight and gestational age of these 14 infants were 2550 +/- 430 g and 36.3 +/- 1.7 weeks, and the mortality was 14%. This study demonstrated that elective delivery can produce severe neonatal complications, that despite their availability diagnostic tests of fetal age and maturity of the fetal lungs are not being used universally, and that the indications for elective delivery in cases of premature rupture of the membranes must be re-evaluated.     

重症监护病房呼吸机相关肺炎的病原菌分布及耐药性分析

目的:研究重症监护病房(ICU)呼吸机相关肺炎的病原菌分布及耐药性情况。方法:采集2016年4月-2017年8月于我院ICU住院治疗的58例呼吸机相关肺炎患者痰样本进行病原菌培养,观察病原菌分布情况。同时对主要病原菌进行药敏试验,分析病原菌对头孢他啶、头孢曲松、环丙沙星、奈替米星、妥布霉素、氨曲南、亚胺培南、阿米卡星八种常见抗生素的耐药性情况。结果:58例呼吸机相关肺炎患者共培养204株病原菌,204株病原菌中根据占比分别为革兰氏阴性菌69.61%(142/204)、真菌15.20%(31/204)以及革兰氏阳性菌15.20%(31/204),且革兰氏阴性菌占比均明显高于真菌以及革兰氏阳性菌(P0.05),其中革兰氏阴性菌中肺炎克雷伯菌占比21.08%(43/204)、铜绿假单胞菌占比18.14%(37/204)、鲍氏不动杆菌占比10.78%(22/204)、产气肠杆菌占比9.31%(19/204)。呼吸机相关肺炎患者病原菌中肺炎克雷伯菌、产气肠杆菌、金黄色葡萄球菌对亚胺培南的耐药性均低于其他七种抗生素,差异有统计学意义(P0.05),铜绿假单胞菌对奈替米星的耐药性均低于其他七种抗生素,差异有统计学意义(P0.05),鲍氏不动杆菌耐药性均较高。结论:ICU中呼吸机相关肺炎主要是由革兰氏阴性菌引发,且耐药情况不容乐观,其中革兰氏阴性菌对亚胺培南最为敏感,值得临床重点关注。     

Pathological and microbiological studies on calf pneumonia occurring in mass rearing facilities

Pathological and microbiological studies were conducted on lesions in the lungs of 194 calves from mass rearing facilities. Macroscopically, the lesions were classified into six forms: nonlesion, atelectasis, mild pneumonia, moderate pneumonia, advanced pneumonia, and advanced pneumonia accompanied with abscess. Histopathological examination revealed bronchopneumonia in most of the calves. Lesions more advanced than moderate pneumonia were complicated with desquamation, severe exudation, and necrosis. Bacteriologically, Pasteurella sp. was isolated often in combination with Staphylococcus sp. from about a half of the atelectatic cases. With the development of pneumonic lesions, Pasteurella sp. was isolated at a high frequency in combination with Haemophilus sp., Streptococcus sp., and Corynebacterium sp. Prominent necrosis was more often seen in cases with Pasteurella haemolytica isolated than in cases with only Pasteurella multocida isolated. Mycoplasma sp. and Ureaplasma sp. were isolated from distinctly pneumonic lesions. Advanced pneumonic lesions were observed in many calves over 30 days of age. The importance of environmental and managerial improvement was also emphasized, since calf pneumonia tended to break out in facilities under unsatisfactory conditions in the present work.     

急性呼吸窘迫综合征新生儿肠道菌群特征及其对免疫功能的影响

研究急性呼吸窘迫综合征(ARDS)新生儿肠道菌群特征及其对免疫功能的影响。

采用前瞻性研究方法, 以我院2017年1月至2021年1月诊断的新生儿急性呼吸窘迫综合征患儿120例作为研究对象, 其中轻度患儿39例, 中度患儿45例, 重度患儿36例, 另选取同期出生的健康新生儿120例作为对照组, 收集患儿的粪便样本并保存于厌氧菌稀释液, 使用MRS琼脂培养基、KF琼脂培养基、马丁培养基检测肠道双歧杆菌、肠球菌、乳杆菌以及真杆菌的数量, 比较各类患儿肠道菌群、免疫指标的差异。

观察组患儿肠道双歧杆菌(t=16.217, P < 0.001)、肠球菌(t=10.677, P < 0.001)、乳杆菌(t=8.326, P < 0.001)以及真杆菌(t=12.455, P < 0.001)数量显著低于对照组。轻度组、中度组以及重度组患儿肠道双歧杆菌(F=13.069, P < 0.001)、肠球菌(F=10.269, P < 0.001)、乳杆菌(F=12.036, P < 0.001)以及真杆菌(F=10.698, P < 0.001)数量之间的差异有统计学意义。患儿出生后第10天肠道乳杆菌[(8.37±0.53)lg CFU/g]、双歧杆菌[(9.89±1.61)lg CFU/g]、肠球菌[(7.903±2.12)lg CFU/g]以及真杆菌[(7.12±1.29)lg CFU/g]数量显著低于出生后第20天时的肠道乳杆菌[(8.99±0.31)lg CFU/g]、双歧杆菌[(10.62±2.64)lg CFU/g]、肠球菌[(8.51±2.28)lg CFU/g]以及真杆菌[(7.91±1.01)lg CFU/g]数量(均P < 0.05)。观察组患儿血清补体C3(t=14.183, P < 0.001)、补体C4(t=9.002, P < 0.001)、IgM(t=11.904, P < 0.001)、IgG(t=147.674, P < 0.001)水平显著低于对照组, 而IgA(t=13.874, P < 0.001)水平显著高于对照组。轻度组、中度组以及重度组患儿血清补体C3(F=11.369, P < 0.001)、补体C4(F=10.396, P < 0.001)、IgM(F=11.003, P < 0.001)、IgG(F=9.663, P < 0.001)、IgA(F=9.245, P < 0.001)之间的差异均有统计学意义。C3、C4、IgM、IgG水平从高到低依次为轻度组、中度组以及重度组。IgA水平从高到低依次为重度组、中度组以及轻度组。肠道双歧杆菌、肠球菌、乳杆菌以及真杆菌与C3、C4、IgM、IgG水平呈正相关, 与IgA水平呈负相关。

ARDS新生儿肠道菌群与免疫功能具有显著相关性, 未来可作为临床治疗的重要靶点之一。

     

血清乳酸脱氢酶评估颅脑手术患者重症肺炎的临床价值

摘要 目的：分析血清乳酸脱氢酶在评估颅脑手术患者重症肺炎的中的应用价值。方法：选取2020年7月~2022年6月在本院神经外科进行收治的颅脑择期手术患者268例,根据是否合并术后肺炎,分为非感染组（n=185）和肺炎组（n=83）,肺炎组根据肺炎严重程度分为重症肺炎31例及普通肺炎52例。采用酶联免疫吸附法测定血清PCT、CRP水平;采用酶比色法检测血清 LDH 水平,采用Pearson相关性检验分析合并肺炎患者血清LDH、PCT、CRP水平与病情严重程度的相关性。采用ROC曲线分析血清LDH、PCT、CRP水平对颅脑手术患者合并重症肺炎的临床诊断价值,血清LDH、PCT、CRP水平预估颅脑手术合并重症肺炎患者预后的价值。结果：术后1 d、3 d、7 d与未感染组对比,普通肺炎组患者血清LDH、PCT、CRP水平均明显升高（P<0.05）;与普通肺炎组对比,重症肺炎组患者血清LDH、PCT、CRP水平均明显升高（P<0.05）。经Pearson相关性检验分析,颅脑手术合并肺炎患者血清LDH、PCT、CRP水平与PSI评分呈明显正相关（P<0.05）。以术后1 d血清LDH、PCT、CRP水平建立ROC曲线,结果发现,血清LDH、PCT、CRP的曲线下面积分别为0.840、0.825、0.746。以术后7 d血清LDH、PCT、CRP水平建立ROC曲线,结果发现,血清LDH、PCT、CRP的曲线下面积分别为0.819、0.725、0.684。结论：LDH在颅脑手术合并肺炎患者中高表达,与肺炎严重程度正相关。LDH在区分非重症肺炎患者和重症肺炎患者以及预测重症肺炎患者的28天死亡率方面具有良好价值。     

Pneumonia in renal transplant patients.

Between January 1976 and March 1982, 28 episodes of pneumonia occurred in 26 renal transplant patients. The overall mortality rate was 46%. Of the 16 patients with nosocomial pneumonia 9 (56%) died, whereas of the 12 patients with community-acquired pneumonia 4 (33%) died. In all 9 cases of unknown cause the response to empiric treatment was prompt, whereas in 4 of the 10 cases of monomicrobial pneumonia and 8 of the 9 cases of polymicrobial pneumonia the patient died. Cytomegalovirus was the sole cause of the pneumonia in two patients and a contributing cause, along with aerobic gram-negative bacteria, in another five, four of whom also had a fungal infection. Two patients, both of whom survived, had nosocomial Legionnaires'' disease.     

The role of genetic determinant in the development of severe perinatal asphyxia

The frequency of GSTT1 and GSTM1 gene deletion polymorphism was determined in a case-control study of full-term Ukrainian newborns including patients with perinatal asphyxia. Multiplex polymerase chain reaction was used for genotyping 245 full-term newborns. The investigated full-term newborns with perinatal asphyxia were subdivided in the subgroups depending of severity of perinatal asphyxia and neonatal outcome. No significant differences in allele frequencies of homorygous null genotypes of GSTT1 and GSTM1 gene were detected among newborns with moderate perinatal asphyxia and healthy control. However, association with the development of severe perinatal asphyxia was detected for the deletion polymorphism in GSTT1 gene and the combination of the GSTT1 absent/GSTM1 absent in the newborns. The study shows that severe perinatal asphyxia may develop in the consequence of genetic predisposition to this condition as compare with moderate.     

妊娠合并肺炎及甲型H1N1 流感的处理及预防探讨

目的:探讨妊娠合并肺炎及甲型H1N1流感的处理及预防措施。方法:我院2009年3月至2010年5月收治的12例妊娠合并肺炎及7例妊娠合并甲型H1N1流感的情况,包括对年龄、孕周、病情、其他合并症、辅助检查、治疗情况及转归进行回顾性分析。结果:19例经治疗后治愈14例,死亡5例,均为晚期妊娠,其中4例合并重症肺炎,1例合并重度子痫前期。12例妊娠合并肺炎者,死亡3例,治愈9例;7例妊娠合并甲型H1N1流感者,死亡2例,治愈5例。结论:妊娠合并肺炎及甲型H1N1流感者,病情控制越及时,母儿结局越好,若病情不见好转,应尽早终止妊娠。     

可溶性细胞间粘附分子-1在新生儿缺氧缺血性脑病血清中的表达及临床意义

目的：探讨可溶性细胞间粘附分子-1（ICAM-1）在新生儿缺氧缺血性脑病（HIE）血清中的表达及其与病情严重程度的关系。方法：采用酶联免疫吸附双抗体夹心法（ELISA）检测45例HIE新生儿和50例健康新生儿血清中可溶性ICAM-1水平。结果：HIE组血清可溶性ICAM-1浓度为（159．25±25．62）ng／ml,对照组血清可溶性ICAM-1浓度为（53．35±12．42）ng／ml,两组相比较有显著性并差异（P〈0．05）;轻、中、重度HIE患儿血清可溶性ICAM-1浓度与对照组比较显著升高（P〈0．05）,在HIE各组中可溶性ICAM-1浓度为重度〉中度〉轻度,各组相比较有显著性差异（P〈0．05）;HIE患儿血清可溶性ICAM-1水平与临床分度呈正相关相关（r=0．652,P〈0．01）。结论：可溶性ICAM-1在HIE新生儿血清中呈高表达,可溶性ICAM-1的水平与病情严重程度密切相关。可溶性ICAM-1在新生儿缺氧缺血性脑损伤中起着重要作用：     

Pneumocystis carinii pneumonia in the rat model.

Groups of barrier-raised but not certified virus-free Sprague-Dawley rats, obtained from the same source over the course of several years, were placed on an identical immunosuppressive regimen. This caused reactivation of latent Pneumocystis carinii infection, manifest as P. carinii pneumonia (PCP) of varying severity. Rats were euthanized after 9-12 wk of immunosuppression. An assessment of the severity of the induced PCP was made, based on the total number of organisms extracted from the lungs and their ability to proliferate in short-term cell culture. Serum samples obtained at sacrifice were tested by indirect immunofluorescence for antibodies to coronavirus, parvovirus, Sendai virus, pneumonia virus of mice (PVM) and Mycoplasma pulmonis. A total of 60 rats were examined. Thirty-four of these (57%) developed moderate or severe PCP. No antibodies were detected to either coronavirus or Mycoplasma pulmonis in any of the rats. Although antibodies were detected to parvovirus in 13/60 (22%), to PVM in 29/60 (48%), and to Sendai virus in 47/60 (78%), there was no apparent correlation between the presence or absence of antibodies to these agents and the severity of PCP. Sequential observations during the course of immunosuppression are needed to clarify the role of concomitant infections in the development of PCP.     

Reducing Deaths from Severe Pneumonia in Children in Malawi by Improving Delivery of Pneumonia Case Management

Objective

To evaluate the pneumonia specific case fatality rate over time following the implementation of a Child Lung Health Programme (CLHP) within the existing government health services in Malawi to improve delivery of pneumonia case management.

Methods

A prospective, nationwide public health intervention was studied to evaluate the impact on pneumonia specific case fatality rate (CFR) in infants and young children (0 to 59 months of age) following the implementation of the CLHP. The implementation was step-wise from October 1^st 2000 until 31^st December 2005 within paediatric inpatient wards in 24 of 25 district hospitals in Malawi. Data analysis compared recorded outcomes in the first three months of the intervention (the control period) to the period after that, looking at trend over time and variation by calendar month, age group, severity of disease and region of the country. The analysis was repeated standardizing the follow-up period by using only the first 15 months after implementation at each district hospital.

Findings

Following implementation, 47,228 children were admitted to hospital for severe/very severe pneumonia with an overall CFR of 9•8%. In both analyses, the highest CFR was in the children 2 to 11 months, and those with very severe pneumonia. The majority (64%) of cases, 2–59 months, had severe pneumonia. In this group there was a significant effect of the intervention Odds Ratio (OR) 0•70 (95%CI: 0•50–0•98); p = 0•036), while in the same age group children treated for very severe pneumonia there was no interventional benefit (OR 0•97 (95%CI: 0•72–1•30); p = 0•8). No benefit was observed for neonates (OR 0•83 (95%CI: 0•56–1•22); p = 0•335).

Conclusions

The nationwide implementation of the CLHP significantly reduced CFR in Malawian infants and children (2–59 months) treated for severe pneumonia. Reasons for the lack of benefit for neonates, infants and children with very severe pneumonia requires further research.     

经纤维支气管镜灌洗治疗儿童顽固性肺炎的临床研究

目的:探讨经纤维支气管镜灌洗治疗儿童顽固性肺炎的治疗效果。方法:选择儿童顽固性肺炎患者48例,随机选择26例行纤维支气管镜灌洗治疗+常规治疗(实验组),另22例行单存常规治疗(对照组),对比两组治疗方案的有效率。结果:实验组22例(84.62%)有效,肺炎治疗有效时间为(9±2.1)d,对照组12例(54.55%)有效,肺炎治疗有效时间为(15.6±3.8)d。实验组肺炎治疗有效率明显高于对照组(p<0.05),且肺炎治疗有效时间明显少于对照组(p<0.05)。结论:纤维支气管镜灌洗是治疗儿童顽固性肺炎的一种有效方法。     

早期肠内营养和肠外营养对ICU中重症肺炎患者预后的影响

目的:研究早期肠内和肠外营养对ICU中重症肺炎患者预后的影响。方法:选取2013年1月-2014年1月我院重症医学科60例重症肺炎患者随机分为肠内营养组30例(enteral nutrition,EN组)和完全肠外营养支持组30例(total parenteral nutrition,TPN组),经过营养支持治疗后,将两组的免疫、营养以及有创机械通气的时间等指标进行比较。结果:肠内营养组与肠外营养组对比发现,在第5天、第10天EN组血清免疫球蛋白和T细胞亚群细胞数显著升高(P0.05);血红蛋白(HGB)、白蛋白(ALB)和血清前白蛋白(PAB)明显升高(P0.05);有创机械通气时间缩短(P0.05),差异具有统计学意义。结论:ICU中重症肺炎应选择肠内营养支持方式,肠内营养能有效的改善营养状态,并能改善患者的免疫功能,减少有创机械通气时间。     

Combined antibiotic therapy of acute radiation disease in persons affected during the accident at the Chernobyl nuclear power station

One hundred and fifteen patients with acute radiation disease of degrees I to IV affected during the accident at the Chernobyl APS were treated in a specialized hospital. The anti-infection regimen included isolation, air sterilization with ultraviolet light, intravenous administration of broad spectrum of antibiotics (gentamicin, cephalosporins and carbenicillin) and nystatin. Some cases were treated with amphotericin. Some cases were treated with amphotericin B. Out of 22 patients who died at the early periods (days 14 to 34) or at the period of agranulocytosis in 7 patients sepsis was stated. In 5 of them it was complicated by pneumonia. In 5 patients who died at the late periods (days 48 to 99) or at the period of hemopoiesis normalization infectious complications by the death moment were stated: sepsis in 3 patients and pneumonia in 2 patients. The aspect of the microbiological diagnosis and therapy efficacy is discussed.     

Depression remission after six months of collaborative care management: role of initial severity of depression in outcome

Aim The impact of initial severity of depression on the rate of remission has not been well studied. The hypothesis for this study was that increased depression severity would have an inverse relationship on clinical remission at six months while in collaborative care management.Participants The study cohort was 1128 primary care patients from a south-eastern Minnesota practice and was a longitudinal retrospective chart review analysis.Results Clinical remission at six months was less likely in the severe depression group at 29.6% compared with 36.9% in the moderately severe group and 45.6% in the moderate depression group (P < 0.001). Multivariate analysis of a sub-group demonstrated that increased initial anxiety symptoms (odds ratio [OR] 0.9645, 95% confidence interval [CI] 0.9345–0.9954, P = 0.0248) and an abnormal screening for bipolar disorder (OR 0.4856, 95% CI 0.2659–0.8868, P = 0.0187) predicted not achieving remission at six months. A patient with severe depression was significantly less likely to achieve remission at six months (OR 0.6040, 95% CI 0.3803–0.9592, P = 0.0327) compared with moderate depression, but not moderately severe depression (P = 0.2324). There was no statistical difference in the adjusted means of the PHQ-9 score for those patients who were in remission at six months. However, in the unremitted patients, the six-month PHQ-9 score was significantly increased by initial depression severity when controlling for all other variables.Conclusion Multivariate analysis in our study demonstrated that patients with severe depression have a decreased OR for remission at six months compared with moderate depression. Also, there was a significant increase in the six-month PHQ-9 score for those unremitted patients in the severe vs. moderate depression groups.     

肾综合征出血热胸部并发症的CT 表现

目的:总结肾综合征出血热(EHF)胸部并发症的CT表现和探讨胸部CT表现对肾综合征出血热的诊断价值。方法:分析60例经HFRS-IgM阳性确诊的HFRS的胸部螺旋CT表现,其中轻型5例、中型20例、重型28例、危重型7例。结果:肺部感染22例,肺水肿12例,胸腔积液41例,心包积液17例,其中,心包积液合并肺水肿者4例,肺部感染并胸腔积液者4例,胸腔积液合并下肺局部膨胀不全18例,胸部CT检查正常8例。结论:肾综合征出血热,胸部并发症发生几率较高,以胸腔积液及胸腔积液并下肺膨胀不全发生几率最高,HFRS的胸部CT表现对于临床有很好的治疗意义,早期CT检查可准确显示肾综合征出血热病人胸部改变的特征。