2009甲型H1N1流感儿童胸X线片表现

Chest radiographic findings in children with 2009 influenza A （ H1N1 ） virus infection

目的 总结儿童2009甲型H1N1流感的胸部X线影像特点.方法 选取2009年5月1日至2010年1月31日经首都儿科研究所病毒研究室病原学检测确诊且影像学资料完整的2009甲型H1N1流感患儿235例,按病情分为轻度组（172例）、中度组（49例）、重度组（14例）,对患儿发病至首次拍片时间以及首次胸X线片影像表现进行比较.三组间性别、影像表现差异使用χ^2检验.患儿年龄及发病至首次拍片时间的比较使用非参数检验.结果 各组患儿年龄、性别差异无统计学意义（P＞0.05）.3组发病至拍摄胸X线片的时间分别为：轻度组（5.91±1.64）d,中度组（3.60±1.43）d,重度组（1.21±0.41）d,3组间差异有统计学意义（χ^2=13.368,P＜0.01）.首次胸X线片影像异常率：轻度组79.7%,中度组91.8%,重度组100.0%,在胸X线片表现上,各组出现肺纹理粗重、模糊（轻度组55.2%,中度组83.7%,重度组78.6%）,肺实变（轻度组34.3%,中度组69.4%,重度组100.0%）,肺过度充气（轻度组22.1%,中度组44.9%,重度组50.0%）以及磨玻璃密度影（轻度组0.6%,中度组2.0%,重度组14.3%）的比例差异均有统计学意义（P＜0.01）.重度组病灶分布广、不对称,累及多个肺叶.结论 儿童2009甲型H1N1流感首次胸X线片出现异常时间、异常率、胸X线片表现严重度与临床病情严重程度成正比.

Objective To evaluate chest radiographic findings of children with 2009 influenza （ H1N1 ） virus infection. Method Data of 235 patients who had microbiologically confirmed H1N1 infection and available chest radiograph obtained between May 1st 2009 and Jan. 31st 2010 were retrospectively analyzed. The final study group was divided on the basis of clinical course [group 1 mild, outpatients without hospitalization （ n = 172 ）; group 2 moderate, inpatients with brief hospitalization （ n = 49 ）; group 3 severe, ICU admission （n = 14）]. Four pediatric radiologists reviewed all the chest radiographs of lung parenchyma, airway, pleural abnormalities and also anatomic distribution of the disease. Result No significant sex or age differences were found among the study groups （ P 〉0.05 ）. The mean interval between the onset of clinical symptom and the initial chest radiography was （5.91 ± 1. 64） days （group 1 ）, （3.60 ±1.43 ） days （ group 2） and （ 1.21 ± 0.41 ） days （ group 3 ）, respectively. The differences among the three groups were significant statistically （ χ^2 = 13.368, P 〈 0.01 ）. The ratio of abnormality presented at initial chest X-ray was 79.7% in group 1,91.8% in group 2 and 100% in group 3. Radiographically, there were prominent peribronchial markings （ group 1, 55.2%; group 2, 83.7%; and group 3, 78.6% ）,consolidation （ group 1, 34.3%; group 2, 69.4%; and group 3, 100.0% ）, hyperinflation （ group 1,22.1%; group 2, 44.9%; and group 3, 50.0% ） and ground glass opacity （ group 1, 0.6%; group 2,2.0%; and group 3, 14.3% ） in the chest radiographs. The differences of presenting were statistically significant （P 〈0.01 ）. In the severe group, the lesions distributed diffusely and asymmetrically with multi lobe involvements. Conclusion In children with 2009 influenza A H1N1 viral infection, the interval between the onset of clinical symptom and initial chest radiography, the ratio of abnormality presented at initial chest X-ray film and the severity of chest film are parallel to their clinical situation.