2009甲型H1N1流感住院患儿多中心临床研究

Multi-center investigation of the hospitalized children with 2009 influenza A （ H1N1 ） infection

目的 了解2009年全国多中心2009甲型H1N1流感住院患儿的临床特征,探讨危重症的高危因素和死亡原因.方法 对2009年秋冬季全国17家医院的810例2009甲型H1N1流感住院患儿的临床表现、实验室检查结果以及治疗和转归进行回顾性总结和分析.结果 810例住院患儿中,男508例,女302例,年龄中位数为43个月,其中＜5岁550例（67.9%）,合并基础疾病148例（18.5%）.常见的表现及例数为：发热780例（96.3%）,流涕294例（36.3%）,鼻塞192例（23.7%）,咽痛147例（18.1%）,咳嗽759例（93.7%）,咯痰347例（42.8%）,喘息219例（27.0%）,呼吸困难163例（20.1%）,呕吐130例（16.0%）,腹泻66例（8.1%）,烦躁79例（9.8%）,嗜睡64例（7.9%）,惊厥32例（4.0%）.常见的实验室异常为：外周血白细胞计数增高或降低377例（46.5%）,乳酸脱氢酶增高346例（42.7%）,C反应蛋白增高306例（37.8%）,天冬氨酸转氨酶增高257例（31.7%）,肌酸激酶增高174例（21.5%）.586例（72.3%）合并肺炎,49例（6.0%）合并脑炎/脑病,30例（3.7%）合并心肌炎.危重症患儿183例,其基础疾病、外周血白细胞计数增高、中性粒细胞比率增高、淋巴细胞比率降低和C反应蛋白增高的发生率明显高于非危重症患儿.19例死亡,占危重患儿的10.4%,8例死于脑炎/脑病,10例主要死于严重肺炎和急性呼吸窘迫综合征,其中5例同时伴有脑炎/脑病,1例死于继发性真菌性脑膜炎.结论 2009甲型H1N1流感容易引起全身多脏器损害.有基础疾病、外周血白细胞计数增高、中性粒细胞比率增高、淋巴细胞比率降低和C反应蛋白增高可能是发生危重症病例的高危因素.合并严重肺炎和急性呼吸窘迫综合征,以及脑炎/脑病是导致死亡的主要因素.

Objective The pandemic influenza in 2009 was caused by a new virus, influenza A （H1N1） virus which has never been found in human before. The papers published at different time, in different places by authors from different institutions show different clinical features. Herein, we describe the clinical features of hospitalized children with 2009 influenza A （H1N1） infection from multi-centers all over the country retrospectively. Methods Clinical data of 810 cases with 2009 influenza A （H1N1） infection were collected from 17 hospitals. The clinical characteristics, laboratory abnormalities, treatment and outcomes were retrospectively studied. Result Of the 810 hospitalized children with 2009 influenza A （H1N1） infection, 508 （62.7%） were male, 302 （37.3%） female; the median age was43 months, 550（67.9%） were under 5 years of age; 148 （18.5%） had underlying chronic disease. The common presenting symptoms were fever （ 96.3% ）, runny nose （ 36.3% ）, stuffiness （ 23.7% ） , sore throat （18.1%）, cough （93.7%）, sputum （42.8%）, wheezing （27.0%）, dyspnea （20.1%）, vomiting （ 16.0% ）, diarrhea （ 8.1% ）, irritability （ 9.8% ）, lethargy （ 7.9% ） and seizures （ 4.0% ） . The common laboratory abnormalities were abnormal results of white blood cells counts （46.5%）, elevations of lactate dehydrogenase （ LDH, 42.7%）, elevated C-reactive protein （CRP, 37.8%）, aspartate transaminase （AST, 31.7%） and creatine kinase （CK, 21.5% ）. Clinical complications included pneumonia 586 （72.3%）, encephalopathy/encephalitis 49 （6.0% ）, and myocarditis 30（3.7%）; 183children had critical illness. The incidence of having underlying chronic disease, leukocytosis, neutrophilia,lymphopcnia and elevations of CRP were high in critically ill patients. Totally 19 （2.3%） died, 8 died from encephalopathy/encephalitis; 10 died from severe pneumonia and ARDS, of whom 5 patients were complicated with encephalopathy/encephalitis; 1 died from secondary fungal meningitis. Conclusion Hospitalized children with 2009 influenza A （H1N1） infection may have a wide involvement of organ systems. The risk factors for critical illness were having underlying chronic disease, leukocytosis,neutrophilia, lymphopenia and elevations of CRP. Complications of severe pneumonia, ARDS, and encephalopathy/encephalitis were main causes of death.