重症禽流感H7N9及重症甲型流感H1N1临床特点分析

Clinical analysis of severe avian influenza H7N9 and severe influenza A H1N1

目的:探讨重症禽流感H7N9与重症甲型流感H1N1的临床特点。方法:收集漳州市医院收治的7例重症禽流感H7N9(重症H7N9)与15例重症甲型流感H1N1(重症H1N1)病例,回顾性分析患者一般情况、基础病、临床症状、检验结果、影像学检查结果、治疗与预后等资料。结果:22例患者中,≥2种基础病的患者死亡率(72.73%)高于≤1种基础病患者死亡率(18.18%)(P<0.05);重症H7N9患者外周血淋巴细胞下降率(100%)高于重症H1N1患者(26.67%)(P<0.05);重症H7N9患者肺实变、胸腔积液与心包积液发生率分别为71.43%、85.71%、57.14%,高于重症H1N1患者的13.33%、13.33%、0(P<0.05);重症H7N9患者需要机械通气时间为(26.86±13.06)d,高于重症H1N1患者的(7.20±6.46)d(t=4.79,P<0.05);两组患者在出院后的随访中,重症H7N9患者在肺部影像上残留更多的纤维条索灶,吸收更慢。结论:与重症甲型流感H1N1相比,重症禽流感H7N9病情更重,预后更差。

Objective： To investigate the clinical characteristics of severe avian influenza（ H7 N9） and severe influenza A（ H1 N1） to guide the diagnosis and treatment. Methods： Seven cases of severe avian influenza H7 N9 group（ hereinafter referred to as severe H7 N9 group） and 15 cases of severe influenza A H1 N1 group（ hereinafter referred to as severe H1 N1 group） were collected and retrospectively analyzed their similarities and differences in the general situation,basic disease,clinical symptoms,inspection results,imaging examinations,treatment and prognosis. Results： Among 22 patients,the mortality rate of patients with 2 or more than 2 basic diseases was 72. 73%（ 8/11）,and the mortality rate of patients with one or more than one basic disease was 18. 18%（ 2/11）（ P〈 0. 05）. The rate of peripheral blood lymphocyte descent in severe H7 N9 group was 100%（ 7/7） higher than that in severe H1 N1 group（ 26. 67%,4/15）（ P〈 0. 05）. The incident rate of consolidation of lung,pleural effusion and pericardial effusion in the severe H 7 N 9 group respectively were 7 1. 4 3 %（ 5/7）,8 5. 7 1 %（6/7） and57. 14%（ 4/7）,whichwashigherthanthatofsevere H1 N1 group13. 33%（ 2/15）,13. 33%（ 2/15）,0（ 0/15）（ P 〈0. 05）. The time of mechanical ventilation in the severe H7 N9 group was（ 26. 86 ± 13. 06） days in average,which was higher than that of the severe H1 N1 group（ 7. 20 ± 6. 46） days in average（ t = 4. 79,P 〈0. 05）. Through the follow-up visit between these two groups,the severe H7 N9 group had more fibrous stripes in the lung images,which absorbed more slowly.Conclusion： Compared with severe influenza A（ H1 N1）,the severe avian influenza（ H7 N9） is worse in the disease of condition and prognosis.