甲型流感H1N1临床轻型与肺炎型病情及实验室结果对比研究

Study of the Difference in Clinical and Laboratory Results between Patients with Mild and Pneumonic H1N1 Infection

目的探讨轻型与肺炎型H1N1甲型流感临床特点及实验室检查结果异同,为早期诊断肺炎型甲型流感提供依据。方法对承德市2009年9—12月经证实的206例甲型H1N1流感(全部)患者进行血常规、生化全项、胸部X线检查,疑为肺炎者进一步检查胸部CT。根据X线胸片有无片状阴影将全部患者分为轻型与肺炎型两组。结果肺炎组以0～7岁组和≥46岁组发病率最高,两组比较差异有统计学意义(P<0.05)。轻型组(19.9%)血白细胞总数低于正常人数百分比小于肺炎组(34.0%),差异有统计学意义(P=0.04),轻型组(77.6%)白细胞正常人数百分比大于肺炎组(50.0%),差异有统计学意义(P<0.001)。白细胞分类:肺炎组(60.0%)中性粒细胞比率高于正常人数百分比大于轻型组(42.9%),差异有统计学意义(P=0.036);肺炎组(28.0%)单核细胞比率低于正常人数百分比大于轻型组(5.1%),差异有统计学意义(P<0.001)。肺炎组(22.0%)血小板低于正常人数百分比大于轻型组(4.5%),差异有统计学意义(P=0.001)。肺炎组(20.0%)血红蛋白低于正常人数百分比大于轻型组(1.3%),差异有统计学意义(P<0.001)。血电解质:肺炎组血钾(K+)、钠(Na+)、氯(Cl-)低于正常人数百分比超过轻型组,差异有统计学意义(P<0.05)。血清酶学检查发现除了肌酸激酶(CK)以外,肺炎组血清酶学高于正常人数比率均较轻型组高,差异有统计学意义(P<0.05)。结论甲型H1N1发病年龄以8～45岁年龄组人群为高,但肺炎型患者则以0～7岁和≥46岁年龄组为多,性别对病情轻重可能没有影响。白细胞总数低于正常、中性粒细胞比率高于正常提示易患肺炎型H1N1流感。单核细胞比率、血小板计数、血红蛋白低于正常易患肺炎型H1N1流感。血清谷丙转氨酶、谷草转氨酶、肌酸激酶同工酶、乳酸脱氢酶、碱性磷酸酶高于正常,提示易出现肺炎型H1N1流感。

Objective To investigate the difference in clinical and laboratory results between patients with mild and pneumonic H1N1 infection so as to provide a basis for an early diagnosis of pneumonic H1N1 infection. Methods Hematologic laboratory and thoracic radiograph studies were performed in all 206 patients with H1N1 proved by RT-PCR（admitted from September to December 2009） in Chengde City.A computed tomography c（CT） scan of the chest was examined for the suspected patients with pneumonia.All the patients were divided into 2 groups based on whether there was the lamellar shadow in the thoracic radiograph. Results（1） The incidence of pneumonic H1N1 was higher in patients aged 0～7 and ≥46（P0.05）.The percentage of total leukocyte countthe normal was lower in the mild group than in the pneumonic group（19.9% vs 34.0%,P=0.04）,and the percentage of normal leukocyte count was higher in the mild group than in the pneumonic group（77.6% vs 50.0%,P0.001）.The percentage of neutrophil countthe normal was higher in the pneumonic group than in the mild group（60.0% vs 42.9%,P=0.036）,and the percentage of monocyte countthe normal was higher in the pneumonic group than in the mild group（28.0% vs 5.1%,P0.001）.The percentage of platelets countthe normal was higher in the pneumonic group than in the mild group（22.0% vs 4.5%,P=0.001）.The percentage of hemoglobinthe normal was higher in the pneumonic group than in the mild group（20.0% vs 1.3%,P0.001）,The percentages of serum ions K＋,Na＋,Cl＋the normal were higher in the pneumonic group than in the mild group（P0.05）.The percentages of sero-enzymesthe normal,with a exception of CK,were higher in the pneumonic group than in the mild group（P0.05）. Conclusion The H1N1influenza is found more frequently in population aged from 8 to 45,but the pneumonic type in people 0-7 years or ≥46 years.The sex might not be associated with the severity of the disease.The decrease of total leukocyte count and the increase of the neutrophil percentage indicate a tendency of suffering from pneumonic H1N1 infection.People whose monocyte percentage,platelet count and hemoglobin value are lower than the normal are apt to suffer pneumonic H1N1 infection.And the condition that serum ALT,AST,CK-MB,LDH and ALP are higher than the normal shows a predisposition of pneumonic H1N1 infection.