上海地区224例早期新型甲型H1N1型流感病例临床特征、治疗及预后回顾性分析

A retrospective analysis of clinical features, treatments and prognosis of the initial 224 cases of pandemic influenza H1N1 2009 virus infection in Shanghai China

目的 回顾性分析上海地区早期新型甲型H1N1型流感病例的临床特点、治疗及预后.方法 以上海市公共卫生临床中心收治的224例新型A/H1N1型流感患者为研究对象,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、抗病毒治疗后新型A/H1N1病毒核酸转阴时间及住院时间等.结果 （1）男女性别比为1.1∶1,63.8%的患者年龄分布在18～40岁之间;（2）临床表现以发热、咳嗽、咽部充血,中性粒细胞和C反应蛋白（CRP）升高为特征,且男性白细胞和CRP水平显著高于女性[分别为（6.71±2.45）× 10^9/L比（5.74±2.10）× 10^9/L,F=10.063,P=0.002;（16.32±18.27）mg/L比（12.05±11.44）mg/L,F=4.026,P=0.046];（3）女性血清前白蛋白（PA）水平显著低于男性[（244.80±76.05）mg/L比（272.06±93.51）mg/L,F=5.800,P=0.017];（4）经CT确诊为肺炎者占21.9%;（5）治疗后血清CRP水平显著降低[（3.81±4.93）mg/L比（10.80±12.92）mg/L,F=6.709,P=0.013];CD3、CD4及CD8水平显著升高[分别为（1449.46±446.71）个/μl比（700.50±307.46）个/μl,F=57.940,P=0.000;（762.69±255.66）个/μl比（370.08±157.62）个/μl,F=47.587,P=0.000;（592.38±238.24）个/μl比（288.88±164.98）个/μl,F=34.409,P=0.000];（6）新型A/H1N1型流感病程（3.9±1.4）d,治疗后病毒mRNA转阴时间为（3.8±1.3）d,住院时间（5.0±1.7）d.结论 （1）新型A/H1N1型流感临床以发热、咳嗽、咽部充血、CRP和中性粒细胞升高为特征;（2）新型A/H1N1型流感病毒具有多器官分布特性,可影响肝脏合成PA及机体的免疫功能;（3）早期新型A/H1N1型流感临床症状较轻、病程短,奥司他韦疗效肯定,预后良好.

Objective This study＇s objective was to analyze the clinical characteristics of the 2009 influenza A （H1N1） virus,as well as how its clinical characteristics relate to patient gender.Methods A total of 224 2009 influenza A （H1N1） patients cured and discharged by the clinical center for public health of Shanghai between May 24 and July 20,2009 were included in the study.The patients＇ personal information,signs and symptoms,lab and imagery data,disease course,hospitalization period and negative seroconversion duration of nucleic acid after antiviral treatment were analyzed.Results Among the 224 paand 40 years old.Clinical manifestations included fever,cough and congestion of the throat,and lab findings were characterized by elevated C-reaction protein （CRP） and neutrophil,and the levels of white blood cell （WBC） and CRP were significantly increased in male patients compared to female patients[ （6.71 ±2.45） × 10^9/L vs （5.74±2.10） × 10^9/L,F =10.063,P =0.002;（16.32 ±18.27）mg/L vs （12.05±11.44） mg/L,F = 4.026,P = 0.046,respectively ].Female patients had significantly lower serum prealbumin （PA） levels than male patients [ （244.80 ± 76.05） mg/L vs （272.06 ± 93.51） mg/L,F = 5.800,P = 0.017 ].The patients＇ serum CRF levels significantly decreased after the treatment [ （3.81 ± 4.93）mg/L vs （10.80 ± 12.92） mg/L,F = 6.709,P =0.013 ],while the levels of CD3,CD4 and CD8 significantly increased after treatment [ （1449.46 ± 446.71） cell/μl vs （700.50 ± 307.46） cell/μl,F =57.940,P =0.000;（762.69 ±255.66） cell/μl vs （370.08 ± 157.62） cell/μl,F =47.587,P =0.000;（592.38 ±238.24） cell/μl vs （288.88 ± 164.98） cell/μl,F =34.409,P =0.000,respectively].Approximately 29.9% of the patients had abnormal signs on chest CT imagery,and 21.9% had obvious signs indicating pneumonia.The average disease course was （3.9± 1.4） days,the negative seroconversion duration of the mRNA after antiviral treatment was （3.8 ± 1.3） days,and the average hospitalization period was （5.0 ± 1.7） days.Conclusion The most significant lab findings of 2009 influenza A （H1N1） virus was characterized by fever,cough and throat congestion with elevated CRP and neutrophil.The 2009 influenza A （H1N1） strain was able to affect multiple organs,including hepatic synthesis of PA as well as immune functioning.The 2009 influenza A （H1N1） influenza virus strain was clinically mild,with short disease course and good prognosis.