甲型H1N1流感重症肺炎临床分析

Severe Influenza A(H1N1) Pneumonia:Clinical Analysis of 5 Cases

目的分析医院甲型H1N1流感重症肺炎的临床资料,总结防治措施,积累临床救治经验。方法对2009年11月28日-12月5日医院收治的甲型H1N1流感重症肺炎5例临床资料进行回顾性分析。结果 5例甲型H1N1流感患者均系咽拭子标本检测病毒核酸阳性的确诊病例;均表现为Ⅰ型呼吸衰竭,符合重症肺炎诊断标准;伴随症状可表现为胸痛(2例)、乏力(3例)、肌肉酸痛(3例),ALT、AST、LDH、CK、CK-MB增高(5例),CRP明显升高(5例),血小板正常(5例),白细胞减少(3例),白细胞正常(2例);胸部影像学表现为斑片、片状、毛玻璃影及间质性改变,以两侧肺底为主(5例),病灶可以快速进展;5例患者均接受奥司他韦抗病毒、β-内酰胺类联合新喹诺酮类抗感染及氧疗,症状明显好转,咽拭子甲型H1N1流感病毒核酸检测结果转阴性,复查胸部X线及CT病灶好转,康复出院。结论急性起病,发热、咳嗽、咯血、呼吸困难,血常规检查WBC低或不高,胸部影像学显示两下肺为主的斑片、片状及间质性改变,病灶快速进展,伴血LDH、CK、CK-MB、ALT、AST升高者,要高度警惕甲型H1N1流感,尽早检测呼吸道标本甲型H1N1流感病毒核酸,早诊断、早治疗、预后相对较好。

OBJECTIVE To investigate the clinical characteristics of severe influenza A（H1N1） pneumonia,and increase the preventive and therapeutic experience of this disease.METHODS Five patients diagnosed as severe influenza A（H1N1） pneumonia in Shanghai Pulmonary Hospital from Nov 28th to Dec 5th 2009 were involved and their clinical manifestations,laboratory examination,radiological features,clinical management and prognosis were reviewed retrospectively.RESULTS The diagnosis was confirmed by detection of influenza A（H1N1） viral nucleic acid positively in specimens of pharynx swab,type Ⅰ respiratory failure happened in every case and they were categoried into severe.Four males and 1 female were involved into this study with a median age of 42.8 years old（ranged,27 to 52）,and previous good health status.All of patients had the symptoms of fever,cough,bloody phlegm and dyspnea,and the complaint symptoms included chest pain（in 2 patients）,acratia（in 3 patients）,and muscle aches（in 3 patients）.The laboratory examination revealed elevated levels of alanine transaminase（ALT）,aspartate aminotransferase（AST）,lactate dehydrogenase（LDH）,creatine kinase（CK） and isoenzymes of creatine kinase（CK-MB）,remarkable elevated C-reactive protein,normal platelet count and decreased level of leukocyte count（3 cases had decreased）.The predominant radiologic manifestation on chest radiogram was patching infiltrates,ground glass opacities,or ill-defined intestitial opacities,mainly on the bilateral lower field with a rapid progression.All the patients were treated with oseltamivir,antimicrobial drugs（β-lactams combined with respiratory quinolones） and oxygen.After the treatment,their symptoms improved with negative influenza A（H1N1） viral nucleic acid testing,and the lesions resolution.All of them recovered and discharged.CONCLUSIONS It should be pay more consideration to the influenza A（H1N1）,when facing a case with acute onset,symptoms like fever,cough,bloody phlegm or dyspnea,low or normal WBC count,rapid progression of lesions on chest radiogram,accompanying elevation of LDH,CK,CK-MB,ALT,and AST levels,and detect of influenza A（H1N1） virus nucleic acid by respiratory tract specimen as early as possible.Early diagnosis and treatment are helpful for prognosis.