甲型H1N1流感危重症15例临床分析

Clinical analysis of 15 patients with critical and severe novel influenza A(H1N1) virus infection

目的:通过甲型H1N1流感危重症病例资料的回顾性研究,总结甲型H1N1流感危重症患者的临床、实验室检查、影像学、治疗及转归等特点,以指导临床实践。方法:回顾性分析确诊为甲型H1N1流感危重症共15例,对其流行病学、临床表现、实验室检查、影像学表现、治疗及转归等进行统计学处理和综合分析。结果:15例患者中男4例,女11例,平均发病年龄(35.20±18.88)岁,其中8例为孕产妇,4例有慢性基础疾病。疾病加重中位时间为3 d,平均时间(3.13±1.51)d。临床症状无特征性,发热、咳嗽、咯痰、纳差、呼吸困难、气促是主要症状。患者首次血常规检测白细胞总数正常或减低(14例,93.3%)。所有患者前白蛋白均降低,50%以上的患者总蛋白、白蛋白降低。发病初期8例乳酸脱氢酶(LDH)增高,5例LDH增高大于正常值上限2倍且均需呼吸机治疗。胸部CT主要表现为双肺多发实变影及磨玻璃影,以双下肺和胸膜下分布为主。治愈14例,死亡1例,出院4周后随访10例患者胸部CT示炎性反应基本吸收。结论:孕产妇及有基础疾病者易为甲型H1N1流感危重症,疾病进展迅速,疾病加重拐点可能为发病第3天;大多数患者血常规白细胞总数正常或减低,所有患者前白蛋白均减低;发病初期LDH升高大于正常上限2倍以上者病情更加严重;绝大部分患者可治愈,预后良好。

Objective To analyze the clinical,laboratorial, radiological, therapeutic and prognostic features of severe novel influenza A （H1N1） virus infection. Method For 15 subjects with critical and severe illness with novel influenza A （H1N1） virus infection confirmed by detecting influenza H1N1 virus subtype- specific RNA in the People＇s Hospital of Jilin Province from November 2009 to March 2010 were retrospectively reviewed. The demographic and clinical characteristics, laboratory data, radiologlcal features and response to treatment were obtained from medical records. Results There were 4 males and 11 females,with a mean age of （35. 20 ± 18. 88） years.. Among 15 cases ,8 cases were pregnancy and postpartum women and 4 cases had the chronic basic disease. The median time of the disease aggravation was on day 3 of sickness, and the mean time was （ 3. 13 ± 1.15 ） days. Clinical symptoms were nonspecifie, and the main symptoms included fever, coughing, sputum production, anorexia, dyspnea and shortness of breath. The numbers of peripheral white blood cells were normal or decreased level （14 cases ,93.3% ）. The laboratory data indicated that the prealbumin was decreased level in all patients, and more than 50% of the cases were decreased level of total protein and albumin. Eight cases had a evidently elevated level of lactate dehydrogenase （LDH） ,5 cases of whom with a initial LDH level more than 2 fold of the normal value required mechanical ventilation. Chest computed tomography （CT） scan showed patchy distribution of consolidation and ground - glass opacity mainly in peripheral subpleural regions. Fourteen cases were cured and got out of the hospital, and only 1 case died. After 4 weeks, 10 cases＇ chest CT scan showed norreal. Conclusion The cases with chronic basic disease and pregnancy and postpartum women easily become severe novel influenza A （ H1 N1 ） virus infection. The time of the disease aggravation is possibly on day 3 of sickness. Majority of the cases indicate a normal range of increased levels of white blood cells. All the cases have decreased levels of prealbumin. The cases with a initial LDH level more than 2 fold of the normal value are more severe. Most patients could cure and have a good prognosis.