北京季节性甲型流感与2009甲型H1N1流感住院患儿的临床比较

Analysis of clinical manifestations of hospitalized children infected with seasonal influenza A virus and 2009 novel influenza A~ HINI） virus in Beijing

目的比较因甲型流感病毒（季节性和2009甲型H1N1）感染而住院儿童的流行病学及临床特征。方法总结回顾分析首都儿科研究所附属儿童医院2003年1月至2010年1月有明确病原学证据的季节性甲型流感组（季节甲流组）和2009甲型ⅢN1流感组（新型甲流组）感染患儿331例的临床表现、实验室检查等资料。结果（1）2003年至2008年每年季节甲流组患儿住院的高峰时间在冬季，新型甲流组住院患儿集中在2009年11月至2010年1月。（2）季节甲流组患儿发病年龄中位数为35（22—63）个月，新型甲流组年龄为48（36—67）个月，两组患儿发病年龄有显著差异（Z=-6．702，P〈0．01）。（3）季节甲流组和新型甲流组患儿均以发热、咳嗽等流感样症状为主要表现，季节甲流组发热天数5（3～7）d，新型甲流组发热天数6（4～7）d，有显著差异（秩和检验，Z=-7．173，P〈0．01）。（4）新型甲流组出现血小板减少，CRP、AIJT、CK—MB的升高，以及心电图异常的人数高于季节甲流组。（5）新型甲流组有基础病变患儿60例，其比例高于季节甲流组的25例（）（2=12．553，P〈0．01）。（6）季节甲流组患肺炎者75例（49．3％），新型甲流组患肺炎者117例（65．4％），后者肺炎患儿人数高于前者（X^2=8．661，P〈0．01），重症病例人数明显高于季节甲流组（X^2=10．595，P〈0．01），有更高的ICU住院比例（X^2=12．873，P〈0．01）和住院天数（Z=-2．764，P〈0．01）。结论2009甲型H1N1流感病毒作为一种新型变异病毒，致病力更强，有基础疾病的患儿更容易被感染，出现肺部、神经及心脏系统的并发症，住院时间长，病死率高。

Objective The novel influenza A （H1N1） virus firstly detected in April 2009 in Mexico rapidly spread to many countries including the United States and Canada where humans were infected with the H1N1 virus and deaths were reported. The pandemic virus strain had never been detected in specimen of human beings and swine. It was so highly contagious and widely spread that threatened life of humans globally. This study aimed to analyze clinical data of hospitalized children patients with 2009 novel H1 N1 influenza A virus infection confirmed by etiologic tests, and compared with that of seasonal influenza A. Method Clinical manifestations, laboratory and therapy data from the hospitalized children were collected by designed case report form and analyzed, All patients were enrolled from Capital Institute of Pediatrics from January 2003 to 2010. There were 152 cases in seasonal influenza A group, which was composed of 100 boys and 52 girls. Other 93 boys and 86 girls formed 2009 novel influenza A group. Result Influenza A was dominate from 2003 to 2008 and the peak season was December and January, while the peak hospitalized time of 2009 novel H1 N1 influenza was from November 2009 to January 2010. The median age of seasonal influenza group was 35 months, which was lower than that of novel influenza group （ Z =-6. 702,P 〈0.01 ）. Besides, 80. 9% of the patients in seasonal influenza group were infants, while the novel influenza A group was mainly composed of infants and pre-school children （ X2 = 40. 725,P 〈 0. 01 ）. The cases of both groups had influenza-like symptoms at onset and the most common presentations were fever and cough. The duration of fever was much longer in 2009 novel influenza group （Z = -7. 173,P 〈0. O1 ）. Patients in two groups nearly had the same symptoms except cough was more frequently presented by novel influenza A group cases （X^2 = 4. 109,P 〈 0. 05 ）. In laboratory examination, the novel influenza group had more cases with abnormality in blood platelet, CRP, ALT, and CK-MB than that of seasonal influenza group （ X^2 = 7. 562, 17. 245, 4. 398, 6. 217, P 〈 0. 01 ）. Patients in novel influenza A group had more changes in electrocardiogram（ X^2 = 24. 461, P 〈 0. 01 ）. More patients had common underlying medical condition in novel influenza groups than those in seasonal influenza group （X2 = 12. 553, P 〈 0. 01 ）. Furthermore, the groups had different age distribution in underlying medical diseases （~2 = 7. 231, P 〈 0. 05 ）. Children with 2009 novel H1 N1 virus infection tended to catch pneumonia （X^2 = 8. 661 ,P 〈0. 01 ） and became the severe cases （ X2 = 10. 595 ,P 〈 0. 01 ）. They had much higher ICU admission rate （ X2 = 12. 873,P 〈 0. Ol ） and longer hospital stay （Z = - 2. 764,P 〈 O. 01 ）. Conclusion As a new variant of influenza virus A, 2009 novel HI N1 influenza A had stronger pathogenicity. Children with underlying medical conditions had the high risk to be infected and developed severe manifestations.