妊娠合并重症新型甲型H1N1流感患者的临床特点

Clinical features of severe new influenza A （ H1N1 ） in pregnant women

目的 探讨妊娠合并重症新型甲型H1N1流感（简称甲型流感）患者的临床特点. 方法 对河北沧州市中心医院2009年11月26日至12月20日收治的16例重症甲型流感患者的临床资料进行分析. 结果 16例患者均为青年女性,年龄19～30岁,其中妊娠期妇女15例.16例平均白细胞总数为（6.7±3.2）×10^9/L,2例低于4×10^9/L,3例高于10 × 10^9/L;淋巴细胞平均值为（0.78±0.52）×10^9/L,14例〈1×10^9/L;12例进行T细胞亚群CD4/CD8检查,其中7例〈1.4.15例患者血乳酸脱氢酶中位数值为319 U/L（0.80～850.00 U/L）,其中11例增高.16例中4例血钾〈3.5 mmol/L;13例检测免疫相关指标,其中5例补体C4高于360 mg/L,1例〈90 mg/L;4例C3〈750mg/L;免疫球蛋白及免疫复合物检查未见异常.影像学检查示多发性多叶肺炎,主要呈间质样改变或大片实变渗出.需要机械通气辅助呼吸的病例影像学检查符合ARDS影像学表现.4例出现少量胸腔积液,1例合并少量心包积液.2例孕晚期妇女胎死宫内,7例及时剖官产终止妊娠或自然生产者病情稳定. 结论 健康妊娠期妇女是甲型流感的高危人群,并易迅速进展为严重肺炎,甚至出现呼吸衰竭.早期抗病毒、早期终止妊娠、早期氧疗并适时进行机械通气辅助呼吸可改善患者预后.

Objective To investigate the clinical characteristics of severe influenza A（H1N1）in pregnant women. Methods Sixteen patients with severe pneumonia caused by influenza A（H1N1）were included in this study from November 26 to December 20,2009. Results All of the sixteen patients were young women,and 15 of them were pregnant.Leukopenia was observed in 2 cases of the 16 patients,and lymphopenia in 14 cases.Data on the ratio of CD4 cells to CD8 cells were available for 12 patients,and 7 cases of whom had an abnormal CD4/CD8 ratio（〈1.4）.Eleven of the 15 patients had increased serum loactate dehydrogenase levels,which were above 245 U/L .Three patients had elevated creatine kinase levels at admission.Five cases of the 16 patients had decreased scram potassium levels.which were below 3.5 mmol/L. Four patients had C4 levels greater than 36 mg per deciliter,and 4 cases had C3 less than 75 mg per deciliter.All 16 patients had radiologically confirmed pneumonia with bilateral patchy alveolar opacities,affecting 3 or 4 lung quadrants.Findings on chest radiographs were consistent with acute respiratory distress syndrome in all patients requiring mechanical ventilation.A small amount of pleural effusion was found in 4 cages.and pericardial effusion was found in 1 of them.Respiratory distress requiring intubation and mechanical ventilation developed in 9 pregnant patients within the first 24 hours after admission,and 2 of them in the third trimester died.while 7 patients for whom pregnancy was timely terminated recovered. Conclusions Pregnant women with 2009 pandemic influenza A（H1N1）appear to have an increased risk of severe disease characterized by severe pneumonia and respiratory failure.Early anti-viral therapy,early termination of pregnancy,and timely mechanical ventilation may bring clinical benefits to pregnant patients.