13例甲型H1N1流感危重症病例临床资料回顾性分析

Retrospective clinical analysis of 13 severe patients with influenza A(H1N1)

目的探讨甲型H1N1流感危重症患者的临床特征及部分实验室检查的特点。方法回顾性分析13例甲型H1N1流感危重症患者临床资料。结果①13例中女性11例,孕妇7例,多以发热、咳喘等呼吸道症状就诊。②13例中有11例发生轻度肝功能损伤,其中7例孕妇均发生肝功能的损伤,主要表现为谷丙转氨酶(ALT)、谷草转氨酶(AST)不同程度的增高,肝功能损伤多见于病程的第1周;12例出现乳酸脱氢酶(LDH)的升高;8例出现肌酸激酶(CK)的升高。③13例患者最终死亡2例,均为女性,入院时均有ALT、AST的轻度升高,而LDH和CK明显升高,均于发生少尿后48 h内死亡。结论女性尤其是孕妇感染甲流H1N1容易发展为危重症;多数危重症甲型H1N1流感患者伴有轻度肝功能损伤;危重症甲型H1N1流感患者伴有LDH及CK明显升高者预后不良。

Objective To summarize the clinical and laboratory features of severe patients with influzena A.Methods A retrospective analysis was conducted on the clinical and laboratory data of 13 severe patients with influenza A（H1N1） admitted in our hospital from November 2009 to January 2010.Results ①11 of 13 patients were females and 7 patients were pregnant women.Most of the patients had fever and respiratory symptoms such as cough and fever.②Among the 13 patients,11 patients and 7 pregnant women had mild abnormal liver function,mainly with different degrees of elevated alanine transarninase（ALT） and aspartate aminotransferase（AST）.Most abnormal liver function occurred at the first week of onset.Serum level of lactate dehydrogenase（LDH） in 12 patients and creatine kinase（CK） in 8 patients increased.③ 2 patients died,with abnormal liver function and higher serum level of LDH and CK.Once oliguria appeared,the patients died within 48 hours.Conclusion Females,especially pregnant women are prone to severe influenza A infection.Most of the severe influenza patients have mild abnormal liver function and those with obviously high level of serum LDH and CK have unfavourable prognosis.