国内三十年甲型H1N1流感临床及流行特点分析

Influenza A H1N1 virus infection: literature review of clinical and epidemiological features for 881 patients in China in the past thirty years

目的分析国内甲型H1N1流感的临床特点、实验室检查、影像学表现、治疗及转归,提高临床医生对该病的认识。方法系统查阅CNKI、维普网、万方数据知识服务平台数据库,以"甲型H1N1流感"为关键词对1989年1月至2019年8月发表的中文文献进行检索,通过去重、删除资料不完整等文献后,共纳入资料完整文献62篇,共880例患者,加上本文报道的1例共881例患者。分析其临床表现、实验室检查、影像学表现、治疗及转归等资料。结果 881例患者中男477例,女404例,年龄50 d至86岁,平均年龄(20.4±10.0)岁;最常见临床症状是发热(99.4%,876/881),其次为咳嗽(85.0%,749/881)、咳痰(38.1%,336/881)、咽痛(37.0%,326/881)、呼吸困难(33.7%,297/881)以及乏力、全身酸痛(33.5%,295/881)等。实验室检查白细胞多在正常范围,白细胞计数减少249例(28.3%),中性粒细胞升高143例(16.2%),白细胞计数升高141例(16.0%);合并心肌损伤370例(42.0%),肝损害303例(34.4%),肾功能不全84例(9.5%)。影像学主要表现为不同程度的斑点状、斑片状或片状阴影(41.8%,362/866),多伴实变影(19.3%,167/866),少数表现为肺纹理增粗(11.3%,98/866)、磨玻璃影(4.5%,39/866),并发胸腔积液(5.5%,48/866)。最常用治疗方法是抗病毒、抗感染、抗炎、机械通气以及对症支持等治疗。综合治疗效果较好,881例患者死亡37例,病死率为4.2%,患者死亡的主要原因为呼吸衰竭。结论甲型H1N1流感与一般流感病毒感染相似,是一种可防、可控、可治的传染病,经积极综合治疗,多可治愈,且预后良好。

Objective To analyze the clinical features, laboratory examination, imaging findings, treatment and outcome of influenza A H1 N1 virus infection in China, so as to improve the clinicians’ understanding of the disease.Methods One patient with influenza A H1 N1 pneumonia was reported in this hospital. The databases of CNKI, VIP network and Wanfang data were systematically consulted. After removing the duplicate and deleting the incomplete literature published between January 1989 and August 2019, 62 literatures were included, involving 880 patients. Hence,881 patients in total were included. The clinical manifestations, laboratory examination, imaging manifestations,treatment and prognosis were analyzed. Results There were 477 males and 404 females, aged from 50 days to 86 years old, with an average age of(20.4 ±10.0) years. The most common clinical symptoms were fever(99.4%, 876/881), followed by cough(85.0%, 749/881), expectoration(38.1%, 336/881), sore throat(37.0%, 326/881) and dyspnea(33.7%, 297/881),asthenia and general pain(33.5%, 295/881) and so on. Laboratory examination in the leukocyte decreased in 249 patients(28.3%), neutrophil increased in 143 patients(16.2%) and leukocyte increased in 141 patients(16.0%). Myocardial injury was found in 370 patients(42.0%), liver injury in 303 patients(34.4%) and renal insufficiency in 84 patients(9.5%). The main imaging manifestations were spotted, patchy or flaky shadows(41.8%, 362/866) in varying degrees, with consolidation shadows(19.3%, 167/866), thickening of lung texture(11.3%, 98/866), ground glass shadows(4.5%, 39/866),and pleural effusion(5.5%, 48/866). The most common treatments were anti-virus, anti-infection, anti-inflammation,mechanical ventilation and symptomatic support. Comprehensive treatment resulted good effects. There were 37 deaths and the mortality rate was 4.2%. The main cause of death was respiratory failure. Conclusions Influenza A H1 N1 virus infection is a preventable, controllable and treatable infectious disease, which is similar to the general influenza virus. After active comprehensive treatment, most of the influenza A(H1 N1) can be cured and the prognosis is benign.