甲型H1N1流感病毒性重症肺炎患者临床实验室检验及肺功能的随访研究

A long-term follow-up study regarding clinical laboratory and lung fuction of H1N1 virus-associated pneumonia

目的研究甲型H1N1流感病毒性肺后遗症患者3年后的肺功能和临床实验室检验的改变,探讨临床实验室检验在治疗长期肺后遗症的应用价值。方法收集该院2009年9月-2010年1月36例由H1N1流感病毒引起的肺炎患者的临床资料,患者接受药物治疗后1周及(35.7±0.8)个月后症状及临床检验数据。回顾性分析患者随访期与急性期病情的关系以及随访期实验室检验与肺功能异常的联系。结果 36例患者3年的随访期实验室检验数据以及肺功能仍存在异常,总胆红素(TBIL)在随访期与急性期相比差异有统计学意义(P<0.05),男性与女性在恢复期中性粒细胞、血气分析和血清酶均存在显著性差异,肺功能数据显示,随访患者的肺活量(FVC)与第一秒用力呼气容积(FEV1)与正常参考值相比多数降低且均有显著性差异,而FEV1/FVC值中1例<75%,4例>90%,最大呼气中期流速(PEF)、50%呼气流速(PEF50)和75%呼气流速(PEF75)与正常参考值相比差异没有统计学意义,但在大多数患者中,肺一氧化碳弥散量(DLCO/SB)和肺泡气量(TLCO/VA)数值均降低,且差异具有统计学意义,然而在随访期中实验室检查指标与肺功能指标并无相关性。结论甲型H1N1流感病毒性肺炎患者出院3年后,临床实验室检验指标异常和肺功能障碍仍较为常见,通过临床实验室检验指标可能有助于指导甲型H1N1流感病毒性肺炎肺后遗症患者的治疗。

【Objective】 To evaluate long-term pulmonary sequelae on clinical laboratory testing in patients 3 years after novel influenza A（H1N1） virus-associated pneumonia. 【Methods】 Thirty-six patients hospitalized for H1N1 virus-associated pneumonia in our hospital between September 2009 and January 2010 were included. The patients underwent clinical laboratory testing（35.7 ± 0.8） months after the onset of symptoms. Abnormal pulmonary lesion patterns were evaluated. 【Results】 The laboratory data and lung function of the thirty-six patients during the 3-year follow-up period were still abnormal. Total bilirubin（TBIL） in the follow-up period was significantly different from that in the acute phase（P〈0.05）. Neutrophil, blood gas analysis and serum enzymes during the recovery stage were significantly different between the male and female patients. Lung function data showed FVC and FEV1 in most of the follow-up patients were significantly lowered compared with the normal reference values, and FEV1/FVC was less than 75% in 1 case and greater than 90% in 4 cases. PEF, PEF50 and PEF75 had no significant differences compared with the normal values in most of the patients. Carbon monoxide diffusion amount（DLCO/SB） and lung alveolar gas（TLCO/VA）values were lowered with significant differences. However, during the follow-up period the laboratory indexes had no correlation with the pulmonary function indexes. 【Conclusions】 Pulmonary sequelae may remain in the patients with H1N1 virus-associated pneumonia 3 years after the onset of symptoms. Clinical and radiological indicators may aid in predicting long-term pulmonary sequelae.