甲型H1N1流行性感冒轻症患者临床特征及预后分析

Clinical features and prognosis of the mild cases of pandemic influenza H1N1 virus infection

目的 分析甲型H1N1流行性感冒（简称流感）轻症患者的临床特点,并探讨其与性别的关系.方法 以245例经甲型H1N1流感病毒核酸检测确诊的患者为研究对象,主要分析患者基本信息、临床症状与体征、实验室及影像学检查、病程、抗病毒治疗后甲型H1N1病毒核酸转阴时间及住院时间等.计量资料采用统计分析软件SPSS 11.5中的ANOVA程序进行单因素方差分析,以P＜0.05为差异有统计学意义.结果 （1）245例患者中男性130例,女性115例,男女性别比为1.13：1;52.0%（127/245）的患者来源于澳大利亚;64.5%（158/245）的患者年龄分布在18～40岁之间.（2）临床表现以发热（98.4%,241/245）、咳嗽（80.8%,198/245）、咽部充血（95.9%,235/245）,实验室检查C反应蛋白和中性粒细胞升高[分别为71.0%（174/245）和52.2%（128/245）]为特征.（3）血清前白蛋白（pre-A）水平女性明显低于男性[分别为（245.04±75.35）、（273.34±92.18）mg/L,F=5.55,P=0.019].（4）治疗后血清C反应蛋白水平明显降低[治疗后为（4.06±3.47）mg/L,治疗前为（14.54±14.68）mg/L,F=6.18,P=0.016];CD3、CD4及CD8水平明显高于治疗前[CD3治疗后为（1451.23±443.97）个/μl、治疗前为（819.97±375.75）个/μl,F=32.61,P=0.000;CD4治疗后为（771.33±251.92）个/μl、治疗前为（435.36±215.35）个/μl,F=44.43,P=0.000;CD8治疗后为（593.16±237.19）个/μl、治疗前为（342.47±180.12）个/μl,F=28.518,P=0.000].（5）胸部计算机X线体层摄影术（CT）发现异常者占30.6%（75/245）,有明确肺炎表现者占22.0%（54/245）.（6）甲型H1N1流感平均病程为（3.9±1.2）d,治疗后病毒mRNA转阴时间为（3.8±1.4）d,平均住院时间为（5.0±1. 4）d.结论 甲型H1N1流感临床上以发热、咳嗽、咽部充血,以及实验室检查C反应蛋白、中性粒细胞升高为特征.并可影响肝脏合成pre-A及机体的免疫功能,临床症状一般较轻、病程短,预后良好.

Objective Analyze the clinical characteristics of the mild cases of pandemic influenza H1N1 virus infection, as well as the relationship of clinical characteristics and patient genders. Methods A total of 245 influenza A （H1N1 ） patients confirmed by viral nucleic acid detection were included in the study. The patients＇ personal information, signs and symptoms, lab and iconography data, disease course,negative seroconversion duration of new influenza A（ H1N1 ） viral nucleic acid after antiviral treatment and hospitalization stay were analyzed. Measurement data were analyzed using one-way analysis of variance （ANOVA） by software SPSS 11.5. P ＜ 0. 05 was defined as statistically significant. Results （ 1 ） Among the 245 patients, 130 were males and 115 were females, yielding a sex ratio of 1.13： 1. Almost 52. 0%（127/245） of the patients came from Australia,and 64. 5% （158/245） were between 18 and 40 years old.（2） Clinical manifestations included fever （ 98.4% , 241/245 ）, cough （ 80. 8%, 198/245 ） and throat congestion （95.9% ,235/245）,and lab findings were characterized by elevated C-reactioo protein （CRP,71.0% ,174/245） and neutrophil （52. 2%, 128/245）. （3） Female patients had significantly lower serum Prealbumin （pre-A） levels than male patients [（ 245.04 ± 75.3 ） vs （ 273. 34 ± 92. 18 ） mg/L, F = 5.55,P =0. 019]. （4）The patients＇ serum CRF Levels significantly decreased after the treatment [（4.06 ±3.47）vs（ 14. 54 ± 14. 68 ） mg/L, F = 6. 18, P = 0. 016], while the levels of CD3, CD4 and CD8 were significantly increased after treatment [（ 1451.23 ± 443. 97 ） vs （ 819. 97 ± 375. 75 ） cell/μl, F = 32.61, P = 0. 000;（771.33 ± 251.92） vs （435.36 ± 215.35） cell/μl, F= 44.43, P= 0.000; （593.16 ± 237. 19） vs （ 342.47 ± 180. 12） cell/μl, F = 28.518, P = 0. 000, respectively]. （ 5 ） Approximately 30. 6% （ 75/245 ） of the patients had abnormal signs on chest CT iconography ,and 22. 0% （54/245） had obvious signs indicating pneumonia. The average disease course was （ 3.9 ± 1.2 ） days, the average hospitalization stay was （5.0 ±1.4） days, and the negative seroconversion duration of the mRNA after antiviral treatment was （3.8 ±1.4）days. Conclusion The influenza A （ H1N1 ） virus was characterized by fever, cough and throat congestion, with elevated CRP and neutrophil being the most significant lab findings. The influenza A （ H1N1 ） strain was able to affect multiple organs,including being able to affect hepatic synthesis of pre-A as well as immune functioning. The influenza A （H1 N1 ） influenza virus strain was mild clinically, with short disease course and good prognosis.