宁波地区轻重症甲型H1N1流感的流行病学和临床对比分析

Comparative analysis on epidemiological and clinical characteristics between mild and severe influenza A(H1N1) in Ningbo city in 2009

目的对比分析宁波地区轻、重症甲型H1N1流感的流行病学和临床特征。方法回顾分析宁波市传染病院2009年7月1日至2009年12月31日收治的204例患者的临床资料,其中轻症52例,重症152例。结果两组患者均以本地户籍者居多,均无明确接触史。成人患者以青年人群为主,但重症者多见于小儿、老年、伴有肥胖和相关代谢综合征、孕妇或剖宫产术后人群。职业分布均以中青年职员和学生为主。发热、咳嗽、咳痰为其突出及特征表现,两组高热(≥39℃)患者的构成比及发热持续时间比较差异有统计学意义;重症患儿的平均最高体温、流涕及消化道症状、咽部充血及扁桃体肿大均高于重症成人患者。轻症患者无并发症;重症患者并发不同程度肺炎或支气管肺炎,小儿以支气管肺炎为主,成人以肺炎为主。两组患者肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、肝功能及白细胞(WBC)升高异常率比较差异均有统计学意义。重症患者平均住院时间较长。结论重症病例仍以发热及呼吸道改变为主,并发症以支气管肺炎、肺炎、心肌及肝功能损害为主,成人及小儿临床表现不一致。

Objective To compare and analyze the epidemiological and clinical characteristics of patients between mild and severe influenza A（H1N1）in Ningbo city in 2009.Methods The distribution of gender,age,area and clinical data（204 patients from Ningbo Infectious Diseases Hospital） were retrospectively analyzed from July 1,2009 to December 31,2009.The mild influenza A（H1N1） patients were 52 cases and the severe patients were 152 cases.Results Patients in both groups were mainly Ningbo residents and hadn′t obvious contact history with influenza A（H1N1）patients.Adult patients in both groups were mainly young people,while severe patients were more common in children,elderly patients and patients with underlying diseases such as obesity and related metabolic syndrome and pregnancy.Occupational distribution of the 2 groups were mainly young personnels and students.Fever,cough and expectoration were prominent and characteristic features of the disease.There were significantly statistical differences with the ratio of hyperpyrexia（≥39℃） and the duration of fever between the two groups.The average maximum temperature in severe children were higher than in severe adults,and the ratio of runny nose,gastrointestinal symptoms,throat congestion and enlarged tonsils were also higher than others.Severe patients had complications with varying degrees of pneumonia or bronchial pneumonia while mild patients hadn′t any complication.The changes of chest imaging were mainly bronchial pneumonia in severe children and mainly pneumonia in severe adult patients.The ratio of abnormal WBC,CK,CK-MB,LDH and liver function were significantly higher in severe group compared with that in the mild group,thus the average hospitalized days were more in severe group than in the mild group.Conclusion The main changes of patients with severe symptoms are still fever and respiratory symptoms.The main complications of patients with severe symptoms are bronchial pneumonia,pneumonia, myocardial damage and abnormal liver function.There are various clinical manifestations and various abnormalities of auxiliary examination in severe patients and the clinical manifestations of adults reveal out of accord with that of children.