重症甲型H1N1流感并肺炎的临床和影像学特点分析并文献复习(附39例病例报道)(英文)

Clinical and imaging characteristics of hospitalized patients with severe influenza A (H1N1) virus infection and concomitant pneumonia (a report of 39 cases and literature review)

目的探寻新型重症甲型H1N1流感的发病规律,积累诊治经验。方法回顾性分析中南大学湘雅二医院2009年甲型H1N1流感病房收治的诊断为重症甲型H1N1流感并肺炎的39例患者的临床和影像学特点,并结合文献复习。结果发病年龄2岁11月～57岁。既往有基础疾病的患者11例(28.2%),肥胖症1例(2.6%),妊娠4例(10.3%)。起病均有流感样症状(100%),10(25.6%)例出现活动后气促。血气分析提示4例为Ⅰ型呼衰,3例为低氧血症。胸部影像学表现主要为毛玻璃样模糊阴影的背景下,有局部散在、片状的高密度影,既有急性肺间质改变的表现,又有局灶肺实变的表现,但几乎未见典型的大叶性肺炎影像学改变。39例均为确诊病例。入院后立即给予奥司他韦抗病毒治疗,37例病例痊愈,2例患者死亡。结论年龄较大(大于60岁)的人群中发生重症甲流的病例很少,孕妇在此次甲型H1N1流感病毒流行中感染后较易发展为重症;重症主要并发肺炎,以双下肺野分布的磨玻璃样模糊阴影为其典型的影像学表现;发病时间超过48小时仍不应放弃奥司他韦抗病毒治疗。

【Objective】To explore the clinical and imaging characteristics of severe influenza A（H1N1） virus infection and accumulate clinical experiences in diagnosis and treatment of pandemic H1N1.【Methods】A total of 39 patients diagnosed as severe influenza A（H1N1） virus infection and concomitant pneumonia in the Second Xiangya Hospital of Central South University in 2009 were analyzed,and the related literature was reviewed.【Results】Among the 39 patients,the age range at disease onset was from 2 years and 11 months to 57 years,11（28.2%） cases had underlying diseases,1（2.6%） case was over weighted,and 4（10.3%） cases were pregnant.The most common symptoms were influenza-like symptoms（100%）,dyspnea after exercise（25.6%）.Type Ⅰ respiratory failure was found in 4 cases,and hypoxemia in 3 cases.The main signs in chest imaging were that high-density patchy infiltrates locally scattered on the ground-glass attenuation shadow.Both acute pulmonary interstitial and pulmonary consolidation changes were found in the iconography,but typical imaging changes of lobar pneumonia were absent.All the 39 patients were confirmed cases.After admission into the hospital,all the patients were immediately given the antiviral oseltamivir therapy.37 cases recovered and 2 cases died.【Conclusions】From this influenza A（H1N1） virus epidemics study,we find that the elders（60 years and older） seldom have severe diseases,while pregnant women develop into severe cases more easily than ordinary people.The main complication is pneumonia characterized by bilateral ground-glass-like shadow of the lower lungs.Patients who are infected beyond 48 h should not give up the anti-viral oseltamivir treatment.