危重症甲型H1N1肺炎的影像表现及病理组织分析

Imaging and histopathological findings of patients with critical influenza A (H1N1) pneumonia

目的:探讨危重症甲型H1N1肺炎影像表现特征及病理机制,提高对危重症甲型H1N1肺炎的认识与诊断水平。方法:回顾性分析7例危重症甲型H1N1肺炎死亡患者的影像表现,并与尸检病理资料进行比较分析。5例行肺部CT检查,其中1例行胸部X线及CT扫描,2例仅行胸部X线正位片检查。5例尸检,2例尸体解剖。结果:7例甲型流感患者均在发病4～7d出现危重症表现,其中2例患有基础性疾病(糖尿病),1例孕妇;3例X线胸片显示两肺弥漫性模糊密度增高阴影,中下肺为著;5例肺部CT显示两侧中下肺外带、背段及基底段片状实变阴影,其中1例合并出现气胸、肺不张、胸腔积液,1例双上肺内可见薄壁空洞和扩张支气管影。结论:影像学检查是危重症甲型H1N1肺炎的重要诊断评估手段,其表现具有一定特征性,但缺乏特异性,确诊需结合临床与实验室检查。

Objective：To investigate the imaging manifestations and the pathologic basis of critical influenza A （H1N1） pneumonia,in order to improve the knowledge and the diagnostic accuracy of this disease entity.Methods：The imaging features of 7 deceased patients due to critical influenza A（H1N1） pneumonia were retrospectively analyzed,their imaging manifestations were correlated with autopsy materials.Pulmonary CT scanning was performed in 5 cases,with 1 had additional chest radiography,the rest 2 patients had only chest radiography in A-P view.5 patients had autopsy and 2 patients had postmortem examination. Results：All of the 7 cases with influenza A （H1N1） showed critical signs and symptoms in 4~7 days after onset,2 patients had basic disease of diabetes and 1 being pregnant.Bilateral diffuse pulmonary blurred shadows of lung were found in chest radiography of 3 cases,which were most obvious in the middle and inferior parts of lung.Bilateral pulmonary consolidations were showed on CT located at the periphery,apical and basal segments of middle and inferior parts of lung,with 1 case had complicated pneumothorax,atelectasis and pleural effusion and another 1 case had thin-walled cavity and bronchoectasis in the upper part of bilateral lungs. Conclusion： Imaging examination is an important tool for the diagnosis of critical influenza A （H1N1） pneumonia,which showed certain characteristic yet non-specific manifestations.Definite diagnosis can only be made in combination with clinical and laboratory examinations.