不同年龄组甲型H1N1流感患者临床特征及预后分析

Clinical Features and Prognosis in Different Age's Patients Infected by Pandemic Influenza A (H1N1) Virus

目的对不同年龄组确诊甲型H1N1流感患者的临床特征及预后进行分析,为临床该疾病的社区诊治提供帮助。方法从2009-09-01—11-01连续监测以发热、咳嗽、咳痰等呼吸道症状为主诉就诊的病例,体温≥37.5℃。抽取满足上述定义的病例。对检测患者行咽拭子H1N1的RT-PCR检测,将确诊甲型H1N1流感患者分为青少年组(年龄<18岁)和成人组(年龄≥18岁),并对他们的临床症状、血常规、C反应蛋白、胸部X线平片及用药情况、预后等进行观察及随访。结果 104例确诊为甲型H1N1流感的患者,青少年组患者29例,成人组患者75例,临床症状多以呼吸道症状为主,两组患者发热程度,咳嗽、咳痰,恶心、呕吐或腹泻,头痛,全身酸痛,全身乏力,关节痛等症状间差异无统计学意义(P>0.05)。血常规各项目、C反应蛋白水平及胸部X线平片表现两组差异亦无统计学意义(P>0.05)。成人组咳嗽、咳痰持续时间较青少年组显著延长,差异有统计学意义(P=0.006),青少年组的住院率高于成人组,差异有统计学意义(P=0.036)。随访104例甲型H1N1流感确诊患者均痊愈。使用达菲为成人患者11例(11/104,10.58%),104例患者均使用清热解毒中药如清开灵等。结论 H1H1感染青少年与成人后,临床症状、血常规、CRP及胸部X线平片无差异,主要以呼吸道症状为主,但咳嗽、咳痰持续时间在成人较长。实验室检查两组患者白细胞以正常为主,淋巴细胞表现为正常或降低,未见增高,中药可能在抗甲型H1N1流感中具有一定作用。

Objective To analysis the clinical features and prognosis of the patients infected by pandemic influenza A （H1N1） virus in different groups of age, in order to benefit clinical diagnosis and treatment of the disease in community. Methods From September 1 to November 1 of 2009 the patients with the chief complaint of such respiratory symptoms as fever, cough and expectoration whose temperatures ≥37.5℃ were successively monitored. Their throat swabs samples were obtained for detecting the H1N1 RNA by RT- PCR. Then the diagnosed A （H1N1） influenza patients were classified as teenager group （age 〈 18 years old） and adult group （age ≥ 18 years old）. The clinical symptoms, blood routine, C -reactive protein and chest X -rays, as well as the conditions of medication and prognosis were observed and followed up. Results Totally 104 patients were diagnosed as having A （H1N1） influenza and divided as teenager group （29 cases） and adult group （75 cases）. Their clinical features were mainly respiratory symptoms such as fever, cough, expectoration, nausea, vomiting, or abdominal pain, headache, general aching and lassitude, arthralgia. No significant difference was found in clinical features and lab tests and X - rays between two groups （ P 〉 0.05 ）. The duration of cough and expectoration in adult group was significantly longer than that in teenager group （ P= 0. 006 ）. The hospitalized rate in teenager group was higher than that in adult group （ P = 0. 036 ）. The follow -up showed all the 104 patients were cured. Only 11 adult patients （11/104, 10. 58% ） were given oseltamivir. All the 104 patients were given Chinese herbal medications with the action of clearing heat and detoxification like Qingkailing. Conclusion The teenagers and adults infected by H1N1 virus have no significant difference in clinical symptoms, blood routine, CPR and chest X - rays. The symptoms are mainly about respiratory tract injury. However the duration of cough and expectoration is longer in adults. The results of lab tests in both groups are mainly normal in leukocyte count, normal or lower lymphocyte, and no increase of lymphocyte was found. Chinese drug might have effect on H1N1 virus.