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目的 探讨慢性心力衰竭（Chronic Heart Failure, CHF）患者合并不同亚型流感病毒感染的临床特征差异及其独立影响因素，为临床早期识别高危患者、制定个体化防控策略提供依据。方法 回顾性纳入2020年1月至2025年12月于广州中医药大学第二附属医院门诊就诊的300例CHF患者，依据流感病毒核酸检测结果分为非感染组（n=200）与感染组（n=100），感染组进一步分为甲型及乙型流感亚组。比较各组基线资料、临床症状、实验室指标及心功能参数，并采用多因素Logistic回归分析筛选CHF患者合并流感病毒感染的独立危险因素。结果 感染组患者年龄≥65岁、NYHA心功能分级Ⅲ～Ⅳ级、合并糖尿病及慢性阻塞性肺疾病（COPD）比例显著高于非感染组（P<0.05）。不同亚型流感病毒感染后临床表现存在差异：甲型高热（≥39℃）和发热持续时间较长，且NTproBNP、cTnI、cTnT水平显著升高，LVEF较乙流感染患者低（P<0.05）；乙型流感亚组全身水肿发生率显著低于甲型流感亚组（P<0.05）。多因素Logistic回归分析显示，年龄≥65岁、NYHA分级Ⅲ～Ⅳ级及合并糖尿病是CHF患者合并流感病毒感染的独立危险因素（P<0.05）。结论 慢性心力衰竭患者合并不同亚型流感病毒感染后临床特征存在显著差异，甲型流感感染症状更为显著；高龄、重度心衰及合并糖尿病是感染的重要独立危险因素。临床应加强对高危CHF患者流感感染的早期识别，优化个体化防治策略，以降低急性失代偿及死亡风险。
Abstract：Objective To investigate differences in clinical characteristics among patients with chronic heart failure(CHF) complicated by different subtypes of influenza virus infection and to identify independent risk factors, thereby providing a basis for early identification of high-risk patients and development of individualized prevention and management strategies. Methods A total of 300 patients with CHF who attended the outpatient department of Guangdong Provincial Hospital of Traditional Chinese Medicine between January 2020 and December 2025 were retrospectively enrolled. According to influenza virus nucleic acid test results, patients were classified into a non-infected group(n = 200) and an infected group(n = 100). The infected group was further subdivided into influenza A and influenza B subgroups. Baseline characteristics, clinical symptoms, laboratory parameters, and cardiac function indices were compared among groups. Multivariable logistic regression analysis was performed to identify independent risk factors for influenza virus infection in patients with CHF. Results The proportions of patients aged ≥65 years, those with New York Heart Association(NYHA) functional class Ⅲ-Ⅳ, and those with comorbid diabetes mellitus or chronic obstructive pulmonary disease(COPD) were significantly higher in the infected group than in the non-infected group(P < 0.05). Clinical manifestations differed by influenza subtype. Influenza A infection was associated with higher fever （≥39℃ ） and longer duration of fever, accompanied by significantly elevated levels of NT-proBNP, cardiac troponin I(cTnI), and cardiac troponin T(cTnT), as well as lower left ventricular ejection fraction(LVEF), compared with influenza B infection(P < 0.05). The incidence of generalized edema was significantly lower in the influenza B subgroup than in the influenza A subgroup(P < 0.05). Multivariable logistic regression analysis identified age ≥65 years, NYHA class Ⅲ-Ⅳ, and comorbid diabetes mellitus as independent risk factors for influenza virus infection in patients with CHF(P < 0.05). Conclusion Significant differences exist in the clinical characteristics of CHF patients infected with different influenza virus subtypes, with influenza A infection presenting more severe clinical manifestations. Advanced age, severe heart failure, and comorbid diabetes mellitus are important independent risk factors for infection. Early identification of influenza infection in high-risk CHF patients and optimization of individualized prevention and management strategies are essential to reduce the risk of acute decompensation and mortality.
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基本信息:
DOI：10.13242/j.cnki.bingduxuebao.260049
中图分类号:R511.7;R541.6
引用信息:
[1]樊叶,姚耿圳,邹旭,等.慢性心力衰竭患者合并流感病毒感染临床特征及影响因素分析[J].病毒学报,2026,42(03):879-884.DOI:10.13242/j.cnki.bingduxuebao.260049.
基金信息:
国家中医药管理局高水平中医药重点学科建设项目-中医药人才培养重点学科建设项目“中医心病学”(国中医药人教函[2023]85号,zyyzdxk-2023160);国家中医药管理局重点研究室建设项目(国中医药科技发[2012]27号)~~
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