小儿甲型和乙型流行性感冒的临床特点比较

Clinical Features of Influenza A vs B in a Cohort of Pediatric Patients

目的:比较小儿甲型和乙型流行性感冒的临床表现特点。方法:收集从2005年12月到2006年3月于本院确诊流行性感冒78例,经咽分泌物送检聚合酶链反应(PCR)法检测两组病毒抗原;30例甲型流行性感冒阳性,48例乙型流行性感冒阳性,采取回顾性分析,比较两组病例的性别、年龄构成以及临床表现特点。结果:甲型流感组和乙型流感组的性别、年龄构成差异无统计学意义(P>0.05),临床表现中,发热、咳嗽、肌痛、呕吐腹泻、白细胞下降所占比例,两组差别无统计学意义(P>0.05)。而气促、发绀、神经系统改变、肺部湿啰音、X线改变、白细胞升高、CK-MB升高所占比例,甲型高于乙型(P<0.05),有6例呼吸衰竭需要呼吸机治疗者均为甲型流感。平均住院天数,甲型流感(11.8±0.76)d,乙型流感(5.6±0.29)d,两者差异有统计学意义(P<0.05),甲型流感组病毒性肺炎21例,小于1岁婴儿7例(占33%),乙型流感组病毒性肺炎8例,小于1岁婴儿4例(占50%)。结论:甲型流感临床表现较乙型流感严重,较多并有细菌感染、病毒性肺炎、神经系统损害、心肌损害,病程较长。两型流感中,小婴儿患病毒性肺炎的机率较大。

Objective：To evaluate the difference in clinical manifestations between influenza A and B. Methods： Records of 78 children with influenza registered to our hospital between December 2005 and March 2006 were reviewed. Throat swab PCR confirmed 30 cases of influenza A and 48 of influenza B in these children. Data on sex, age, and clinical features of these cases were retrospectively compared between the two types of influenza. Results： The age and sex distribution were comparable in the two groups （ P 〉 0.05 ）. Clinically, percentages of patients with any of fever, cough, myalgia, vomiting, diarrhea and lowered WBC count did not differ between the two types of influenza （P〉0. 05）, while the rates of dyspnea, cyanosis, neurological disorder, pulmonary moist rales, X ray abnormalities, elevated levels of WBC count and CK-MB were higher in influenza A compared with influenza B （ P 〈 0. 05 ）. All of 6 children with respiratory failure necessitating ventilation were of influenza A. The mean hospital stay was （ 11.8± 0. 76 ） days in influenza A vs （ 5.6 ±0. 29 ） days in influenza B （ P 〈 0. 05 ）. Twenty-one children [including 7 aged below 1 year old （33%）] in influenza A vs 8 [ including 4 aged below 1 year old （50%）] in influenza B were complicated with viral pneumonia. Conclusion： Compared with influenza B, clinical features of influenza A appear to be more severe and long-lasting, with frequent complications of bacterial infections, viral pneumonia, nerve system involvement and myocardial injuries. In the both types, younger children are more susceptible to viral pneumonia.