儿童甲型H1N1流感93例临床特征及治疗分析

Clinical feature and treatment of 69 Chinese children patients infected with influenza A （ H1N1 ）

目的分析儿童甲型H1N1流感的临床及实验室特点、治疗效果。方法2009年5月15日-9月10日北京地坛医院收治、确诊为甲型H1N1流感的患儿93例，男59例，女34例。采集患儿就诊时症状信息，观察并记录患儿住院期间临床症状、体征以及相关的临床特殊检查及实验室检查结果。治疗方法采取口服奥司他韦抗病毒、口服中药辨证治疗以及其他对症治疗。对所搜集的临床资料进行分析。结果（1）甲型H1N1流感患儿发病时以发热（84例，90．3％）、咳嗽（62例，66．7％）、咽痛（21例，38．7％）等为主要症状，体征以体温升高、咽部充血（53例，57．0％）、扁桃体肿大（21例，22．6％）为主。白细胞计数异常者32例，血沉异常者10例，C反应蛋白异常者10例，CD4^＋细胞异常者19例，少数患儿出现肝、肾功能异常。（2）采用不同治疗方法后，患儿发热持续时间[中位数（范围）]：单纯用奥司他韦治疗组1（1—6）d、单纯中医药治疗组1．5（1～6）d，中医药与奥司他韦共同治疗组1（1～5）d，未使用奥司他韦及中医药治疗组2（1～5）d；病毒转阴时间[中位数（范围）]：单纯用奥司他韦治疗组7（3～13）d，单纯中医药治疗组8（4～11）d，中医药与奥司他韦共同治疗组8（5～14）d，未使用奥司他韦及中医药治疗组8（4～13）d。结论患儿临床表现与成人相似，中医药可能改善儿童甲型H1N1流感的症状，其他方面的临床疗效有待进一步的研究。

Objective During the 2009 influenza A （ H1N1 ） epidemic in China, children are the main group among people infected with influenza A （H1N1） virus, but few reports about children are available. The present study aimed to observe the clinical, laboratory features and to analyze therapeutic result. Method The research subject were 93 children infected with influenza A （H1N1） , 59 male and 34 female who were treated in Beijing Ditan Hospital from 15 May 2009 to 10 September 2009. The patients＇ data on symptoms, signs, chest X-ray, blood routine test, erythrocyte sedimentation rate （ESR）, C reactive protein （CRP）, liver function, renal function, helper T lymphocyte were collected and analyzed. The patients were treated with Osehamivir, traditional Chinese medicine and symptomatic treatment. Result The main symptoms of children infected with influenza A （ H1N1 ） are fever （ 84 cases, 90. 3% ） , cough （62 cases, 66. 7% ）, pharyngodynia （36 cases, 38.7% ） and expectoration （ 19 cases, 20. 4% ） at onset, and fever （59 cases, 63.4% ） , cough （52 cases, 55.9% ）, pharyngodynia （23 cases, 24.7% ） and expectoration （9 cases, 9. 7% ） were the mojor symptoms and signs while the patients visited our hospital. The main signs were fervescence, pharyngeal congestion （ 53 eases, 57. 0% ）, tonsilar swelling （ 21 cases, 22. 6% ） , and abnormal white blood count （ WBC ） was found in 32 cases, abnormal ESR in 10 cases, abnormal CRP in 10 cases, abnormal CD4 T lymphocyte count in 19 cases, abnormal liver function and renal function were found in very few patients. After treatment, the febrile duration and time to virus negative in patients treated with oseltamivir alone, traditional Chinese medicine alone, combined oseltamivir and traditional Chinese medicine as well as those who were neither treated with osehamivir nor traditional Chinese medicine were respectively 1 - 6 days （ median 1 day）, 3 - 13 days （ median 7 days）, 1 - 6 days （ median 1.5 days）, 4 - 11 days （median 8 days）, 1 -5 days （median 1 days）, 5 - 14 days （median 8 days）, 1 -5 days （median 2 days）, 4 - 13 days （median 8 days）. Conclusion Clinical manifestations of 93 children cases were the same as those of adults. The traditional Chinese medicine could improve symptoms of children infected with influenza A（ H1N1 ）, but other clinical therapeutic effects need further study.