2009年安徽省87例甲型H1N1流感临床特点分析

Clinical analysis of 87 patients with influenza A(H1N1)infection of Anhui Province in 2009

目的探讨安徽省2009年甲型H1N1流感（以下简称＂甲流＂）临床特点,尤其对甲流孕产妇和死亡患者的临床特点进行分析,为甲流的防治提供依据。方法分析安徽省2009年10~12月87例甲流确诊患者的临床表现、实验室和辅助检查结果及预后。结果 87例患者的年龄中位数为30岁,18~44岁患者55例（63.2%）;女性50例（57.5%）;主要临床表现为发热、咳嗽、咽部充血。外周血淋巴细胞百分比降低多见,血清乳酸脱氢酶（lactatedehydrogenase,LDH）和肌酸激酶（creatine kinase,CK）增高多见。双侧肺炎多见,右肺多于左肺。在女性患者中,孕产妇组发热率高于非孕产妇组,差异有统计学意义（P=0.013）,但前者出现肺部口罗音率低于后者（P=0.044）。死亡组（16例）呼吸困难和紫绀、血清丙氨酸氨基转移酶（alanine aminotransferase,ALT）、天门冬氨酸氨基转移酶（as-partate aminotransferase,AST）、CK升高者均多于存活组（71例）（均有P〈0.05）,出现上呼吸道感染症状者少于存活组（P=0.042）。结论孕产妇甲流患者较非孕产妇患者并无特异性临床表现,但在流感季节,对于发热的孕产妇需高度注意甲流感染可能。另外,临床医生需密切关注患者脏器损害程度,早期干预治疗从而降低病死率。

Objective To investigate the clinical characteristics of 87 patients with influenza A（H1N1） infection,and to analyze the clinical features of pregnancy and puerpera cohort and non-survival cohort with influenza A（H1N1） infection especially.Methods A retrospective study was conducted on clinical manifestations,laboratory and auxiliary examinations and outcomes of patients with confirmed influenza A（H1N1） infection in Anhui Province between October and December,2009.Results The median age of 87 patients was 30 years,63.2%（n=55） were from 18 to 44 years.57.5%（n=50） were female.The most common presenting clinical manifestations were fever,cough,pharyngeal portion congestion.It was more popular in decreased blood lymphocyte percent,increased serum lactate dehydrogenase（LDH） levels,increased serum creatine kinase（CK） levels and bilateral pneumonia.The right pneumonia was more frequently involved than the left one.Compared with non-pregnancy and non-puerpera cohort,pregnancy and puerperal cohort has more fever symptom but less bellows rales（P0.05）.In contrast with survival cohort（n=71）,non-survival cohort（n=16） were more likely to have dyspnea,cyanosis,increased serum alanine aminotransferase（ALT） levels,increased serum aspartate aminotransferase（AST） levels,increased serum creatinine kinase（CK） levels,but was less frequently to have symptoms of the upper respiratory tract infection（P0.05）.Conclusions Compared with non-pregnancy and non-puerpera cohort,the pregnancy and puerpera cohort has no special clinical manifestinations,however,clinical doctor should hightlight the possibility of 2009 influenza A（H1N1） infection when a pregnancy or a puerpera patient is running a fever in the flu season.In addition,clinical doctor should give early medical intervention treatment to decrease the mortality by paying close attention to the degree of the patient＇s organ injury.