重症甲型H1N1流感并肺炎的CT表现

目的探讨甲型H1N1流感并肺炎的CT表现。方法 5例临床确诊甲型H1N1流感的重症患者共8次胸部CT扫描(复查3例)资料。结果 5例中均为双肺多叶、多段实变灶,无明显肺叶、肺段或特定体位分布趋势;大片肺实变表现为双侧沿支气管树分布的肺段实变;内有明显的空气支气管征;相邻肺段实变融合或在叶间裂处相邻的肺叶实变扩展,于影像接触部位融合,形成更大片实变影;肺内小病灶均为双肺多发,呈类圆形或棉团状,沿肺纹理分布最多见;大片肺实变可呈均匀致密实变、磨玻璃样变、蜂窝状实变,小病灶与大片实变灶一致,磨玻璃样变可出现在初诊和吸收期病例;反应性胸膜增厚及胸膜积液常见;无纵膈、肺门淋巴结肿大。结论 CT改变提示:甲型H1N1重症病例并肺炎在病程发展阶段,病变有经支气管肺泡系播散的特点。     

甲型H1N1流感合并肺炎16例临床分析

甲型H1N1流感是由变异后的新型甲型H1N1流感病毒所引起的急性呼吸道传染病,通过飞沫、气溶胶、直接接触或间接接触传播,临床主要表现为流感样症状,少数病例病情重,进展迅速,可出现病毒性肺炎,合并呼吸衰竭、多脏器功能损伤,严重者可导致死亡。由于这种甲型H1N1流感是新发疾病,其合并肺炎患者的临床表现、影像学特点及治疗措施有待进一步观察总结。现将我院收治的甲型H1N1流感合并肺炎患者的临床表现及胸部影像学特点报道如下。     

甲型H1N1流感合并肺炎的临床特点分析

目的通过对甲型H1N1流感合并肺炎的临床特点的分析。方法分析2009年月10月-2010年3月在我院入住的29例甲型H1N1流感合并肺炎患者的临床表现、实验室检查及胸部CT等资料。结果本组病例男性16例,女性13例。3例妊娠,13例合并有基础疾病。所有病例均有流感样前驱症状,呼吸道主要症状为发热、干咳少痰,严重者气短、呼吸困难、咯血。合并细菌感染时咯脓痰。肺部听诊无啰音或少啰音,合并哮喘时有哮鸣音,合并细菌感染时可有湿啰音。实验室检查65%白细胞不高或降低,41%心肌酶升高,58.6%存在低氧血症,35%呼吸衰竭。影像学表现多种多样：65.5%主要为单侧或双侧棉团样、团片样边界模糊高密度渗出影伴肺实变,其内见充气支气管征,病变沿支气管血管束分布。轻症及早期较局限,重症者及晚期病变融合呈双肺多发弥漫性改变。少数呈大叶及小叶性肺炎表现。预后大多良好,病死率6.9%。主要死亡原因为呼吸衰竭及大咯血。结论甲型H1N1流感合并肺炎是以甲型H1N1流感病毒肺炎为主要疾病的多种肺炎构成。甲型H1N1流感病毒肺炎临床表现具有流感病毒肺炎共性特点,其影像学表现有一定特征性。     

38例甲型H1N1流感合并肺炎患者的影像学特征

甲型H1N1流感如诊断及时、治疗得当町避免迅速进展为重型肺炎、出现呼吸衰竭和多脏器功能衰竭。回顺性分析我院收治的38例甲型H1N1流感并发肺炎患者的胸部X线及CT影像学特点，为临床诊断提供依据。现报告如下。     

甲型H1N1流感肺炎危重病例的临床分析

目的 分析甲型H1N1流感肺炎危重病例的临床特点及危重症的相关危险因素.方法 采用回顾性研究方法分析承德市第三医院2009年9～12月收治的51例新型甲型H1N1流感肺炎患者的临床特点,并对重症病例和危重症病例进行比较分析.结果 危重症患者均有呼吸困难,氧合指数为(188.4±68.5) mm Hg,APACHEⅡ评分为12.5±4.5.其中10例(41.7％)出现咳痰带血,6例(25.0％)发展至急性呼吸窘迫综合征(ARDS).危重症组在白细胞升高、淋巴细胞降低、血糖升高、痰培养阳性及应用奥司他韦(300 mg/d)、美洛培南、丙种球蛋白、近期康复者血浆、机械通气、糖皮质激素的患者比例上较重症组高(P值均＜0.05);危重症组受损肺野数量、咽拭子转阴时间、住院时间上较重症组高(P值均＜0.05).logistic回归分析结果显示:首发症状有咳痰、发病到应用奥司他韦时间＞48 h、伴随基础疾病是易于发展至危重症的危险因素(OR值分别为3.181、19.596、7.437,P值均＜0.05).结论 首发症状有咳痰、发病到应用奥司他韦时间＞48 l、伴随基础疾病的甲型H1N1流感肺炎患者易发展至危重症;危重症患者受损肺组织广泛且部分合并细菌感染,病毒转阴时间和住院时间长,部分患者进展至ARDS.     

甲型H1N1流感62例临床诊治分析

2009年3月以来,墨西哥、美国暴发了甲型H1N1流感,疫情迅速蔓延。我院2009年6月～9月共收治甲型H1N1流感病例62例,现将其临床表现及治疗情况报道如下。     

甲型H1N1流感合并肺炎的重症及危重症老年患者23例临床分析

甲型H1N1流感早期症状不典型,多与一般的季节性流感症状相似,早期诊断率不高,容易出现误诊、漏诊;一旦合并肺炎的重症及危重症患者,如不能及时有效控制,则病情短期内可急进性进展,导致致命的后果.影像学检查是甲型H1N1流感临床诊断的主要组成部分,也是指导治疗及判断预后的重要依据,有助于肺部损害的客观评估及并发症的早期诊断,对甲型H1N1流感病毒感染者的预后至关重要.     

103例甲型H1N1流感临床分析

目的:探讨2009年甲型H1N1流感的临床特点及预后。方法:回顾性分析2009年8月至2010年1月北京安贞医院98例甲型H1N1流感患者及5例外院会诊重症患者的临床资料。结果:本组病例中平均年龄(31.06±13.43)岁。主要临床表现为发热(100%)、咳嗽(88.3%)及畏寒(81.6%)等。重症及危重症患者中病死率为22.2%,并发症居前3位的是细菌感染、急性呼吸窘迫综合征(ARDS)、多脏器功能衰竭(MODS),其发生率分别为85.7%、57.1%及28.6%。慢性基础性疾病为重症及危重症病例发生的重要影响因素。结论:甲型H1N1流感以青壮年发病为主,主要临床表现为呼吸道症状,重症病例中多存在二重感染,并有可能存在凝血障碍,呼吸性碱中毒,低氧血症或Ⅰ型呼吸衰竭,且存在慢性基础性疾病更易发生。     

新型甲型H1N1流感患者体内病毒载量与胸部CT表现的关系

目的 观察新型甲型H1N1流感(简称甲型流感)患者体内病毒载量与胸部CT表现的动态变化,探讨病毒载量与胸部CT表现对甲型流感的诊断、鉴别诊断及指导治疗的价值.方法 收集2009年5-12月深圳市第三人民医院收治的51例甲型H1N1流感核酸检测阳性的患者,均符合卫生部颁布的"甲型H1N1流感诊断标准",均行胸部X线及CT扫描(含高分辨率CT)并测定体内病毒载量.根据CT影像检查有否肺炎征象将甲型流感患者分为肺炎组31例和非肺炎组20例,观察胸部CT所见与病毒载量变化的关系.结果 (1)甲型流感肺炎组患者胸部CT主要表现为片状实变影,早期和吸收期表现为磨玻璃影,双肺散在小叶性或节段性阴影,以下肺叶多见,左下肺叶明显,可伴有纵隔淋巴结肿大,肺实质、肺间质及胸膜可同时受累;(2)发病甲期患者体内病毒载量高,肺炎组病毒载量的均值为7.7拷贝/ml,非肺炎组为4.2拷贝/ml;抗病毒治疗4 d(病程第6天)病毒核酸开始转阴;(3)3例肺炎患者中2例病毒核酸转阴时间快于胸部CT病灶吸收时间,而1例年幼患者的病毒核酸转阴时间明显延长.结论 甲型流感合并肺炎患者的病毒载量明显高于未合并肺炎的患者;动态观察甲型流感合并感肺炎患者的影像学表现及病毒载量的变化,有利于对甲型流感患者进行及时有效的治疗.     

19例甲型H1N1流感重症患者临床特点分析

目的 分析H1N1流感重症患者临床特点,提高对其诊治水平.方法 对19例甲型H1N1流感重症患者的一般情况、脏器功能病变、病理检查结果、治疗情况及临床预后进行分析.结果 19例患者均存在低氧血症及心肌受损,胸片显示严重的肺水肿.病理检查(2例)提示间质性肺炎、急性呼吸窘迫综合征等病理改变.本组死亡5例,均存在严重慢性基础疾病,28、90 d病死率分别为21.1％和26.3％.结论 甲型H1N1流感重症患者多数预后良好,病情进展迅速者主要表现为呼吸衰竭和多脏器功能障碍综合征.存在严重慢性基础疾病者病死率高.     

Differences in clinical characteristics and chest CT findings between severe and critical H1N1 pneumonia

Introduction

Critical H1N1 pneumonia patients usually have one of the symptoms such as respiratory failure, septic shock, multiple organ dysfunction, or other need for intensive care management, which are associated with high risk of mortality. It is essential to differentiate the severity of H1N1 pneumonia and take corresponding target treatments.

Objectives

We aim to investigate the differences in clinical characteristics and chest computed tomography (CT) findings between severe and critical patients with H1N1 pneumonia.

Methods

A total of 27 patients diagnosed with H1N1 pneumonia from October 2018 to March 2019 were retrospectively analyzed, and the differences in clinical manifestations, laboratory tests, and chest CT findings between the severe group (15 patients) and the critical group (12 patients) were compared.

Results

Frequency of dyspnea at rest was higher in critical group than that in severe group (P = 0.019). The neutrophil percentage was higher (P = 0.014) and the lymphocyte percentage was lower (P = 0.025) in critical compared with severe group. Bilateral lung involvement was the predominant pattern in both severe and critical patients, whereas the number of involved lobes in critical patients was more than that in severe patients (P = 0.024). Peripheral distribution was the predominant pattern in severe patients (40%), whereas more diffuse involvement of the lungs was observed in critical patients (83.30%). Ground-glass opacities and consolidation were the main CT findings in both groups, and prevalence of consolidation was higher in critical relative to severe group (83.30%).

Conclusion

Compared with severe patients, those with critical H1N1 pneumonia were more likely to present with dyspnea at rest and decreased lymphocyte percentage. Chest CT showed that diffuse bilateral involvement and higher prevalence of consolidation are associated with critical outcomes.     

Clinical, laboratory and radiologic characteristics of 2009 pandemic influenza A/H1N1 pneumonia: primary influenza pneumonia versus concomitant/secondary bacterial pneumonia

Please cite this paper as: Song et al. (2011). Clinical, laboratory and radiologic characteristics of 2009 pandemic influenza A/H1N1 pneumonia: primary influenza pneumonia versus concomitant/secondary bacterial pneumonia. Influenza and Other Respiratory Viruses 5(6), e535–e543. Background Although influenza virus usually involves the upper respiratory tract, pneumonia was seen more frequently with the 2009 pandemic influenza A/H1N1 than with seasonal influenza. Methods From September 1, 2009, to January 31, 2010, a specialized clinic for patients (aged ≥15 years) with ILI was operated in Korea University Guro Hospital. RT‐PCR assay was performed to diagnose 2009 pandemic influenza A/H1N1. A retrospective case–case–control study was performed to determine the predictive factors for influenza pneumonia and to discriminate concomitant/secondary bacterial pneumonia from primary influenza pneumonia during the 2009–2010 pandemic. Results During the study period, the proportions of fatal cases and pneumonia development were 0·12% and 1·59%, respectively. Patients with pneumonic influenza were less likely to have nasal symptoms and extra‐pulmonary symptoms (myalgia, headache, and diarrhea) compared to patients with non‐pneumonic influenza. Crackle was audible in just about half of the patients with pneumonic influenza (38·5% of patients with primary influenza pneumonia and 53·3% of patients with concomitant/secondary bacterial pneumonia). Procalcitonin, C‐reactive protein (CRP), and lactate dehydrogenase were markedly increased in patients with influenza pneumonia. Furthermore, procalcitonin (cutoff value 0·35 ng/ml, sensitivity 81·8%, and specificity 66·7%) and CRP (cutoff value 86·5 mg/IU, sensitivity 81·8%, and specificity 59·3%) were discriminative between patients with concomitant/secondary bacterial pneumonia and patients with primary influenza pneumonia. Conclusions Considering the subtle manifestations of 2009 pandemic influenza A/H1N1 pneumonia in the early stage, high clinical suspicion is required to detect this condition. Both procalcitonin and CRP would be helpful to differentiate primary influenza pneumonia from concomitant/secondary bacterial pneumonia.     

The role of initial radiologic and clinical manifestations in predicting the prognosis for pneumonia caused by H1N1 influenza virus

Objective

The aim of this study is to investigate the prognostic values of initial radiologic findings and preexisting medical conditions in pneumonia caused by H1N1 influenza virus that were obtained during the novel swine-origin influenza A (H1N1) virus (S-OIV) pandemic spread.

Methods

Thirty-nine patients hospitalized due to H1N1 infection between September and December 2009 were retrospectively evaluated regarding the radiologic and clinical aspects. The thoracic computed tomography (CT) findings of all patients were assessed and accompanying conditions that may raise the morbidity were stated. The patients were divided into two groups as those who needed the intensive care unit administration and those treated with brief hospitalization; initial radiologic findings and preexisting medical situations of patients were compared among both groups respectively in terms of their prognostic value.

Results

In 39 patients with H1N1 infection (21 males and 18 females; mean age of 53.9±14 in range between 19 and 99 years); the necessity of intensive care was significantly higher in patients with solely chronic obstructive pulmonary disease (COPD) (P=0.008, Odds ratio: 27) or co-existence of COPD and malignity (Odds ratio: 13); however, no statistically significant difference between two groups was observed regarding the radiologic facts or other combinations of accompanying medical conditions in terms of any effects to the prognosis.

Conclusions

In the H1N1 (S-OIV) pandemic, we observed that merely the contribution to the diagnostic process; the radiologic features have no significance as being prognostic indicator. Additionally; the superposition of H1N1 infection in patients with either COPD or COPD by malignity was stated to be a potential risk factor in terms of increased morbidity.     

儿童危重型H1N1流感肺炎伴胸腔积液的临床特征及淋巴细胞亚型特征

目的 分析危重症H1 N1流感患儿合并胸腔积液的临床特征及自身免疫功能的变化.方法 采用回顾性分析方法,收集2017年1月至2020年3月确诊为重症甲流的126例患儿的临床资料.根据有无胸腔积液分为胸腔积液阳性组(n=54)和胸腔积液阴性组(n=72);比较两组间基本临床资料,炎性指标和免疫功能.结果 胸腔积液阳性组与...     

Clinical characteristics and outcomes of hospitalized patients with 2009 H1N1 influenza in a large acute care tertiary hospital, Singapore

This study describes the clinical characteristics and outcomes of hospitalized patients with 2009 H1N1 influenza in a large, acute care, tertiary hospital in Singapore. Of the 265 hospitalized patients with laboratory-confirmed 2009 influenza A (H1N1) during the height of the H1N1 flu pandemic, 13% (35) suffered severe outcomes including a mortality rate of 4.5% (12). Severe outcomes were associated with patients aged 40 years or more, underlying comorbidities, and complicated by pneumonia.     

伴肺炎与低氧血症的新型甲型H1N1流感二例报告

目的 分析2例重症新型甲型H1N1流感(简称甲型流感)合并肺炎患者的临床表现、影像学特点和治疗经过,提高对本病的认识.方法 回顾性分析2009年9月入住南京市第二医院南山分院的2例确诊为甲型流感合并肺炎患者的临床表现、胸部CT特点及治疗经过.结果 2例患者中1例为女性,54岁,无基础疾病;1例为男性,31岁,有支气管哮喘史.主要症状和体征为发热、咳嗽,肺部可闻及湿性哕音.2例患者胸部CT主要表现为实变影及磨玻璃影,以双下肺和胸膜下分布为主,累及多个肺叶、肺段,实变影内可见支气管充气征.2例患者咽拭子甲型H1N1流感病毒核酸阳性,确诊为甲型流感.2例患者入院时均存在低氧血症,白细胞计数和淋巴细胞计数下降,血乳酸脱氢酶(LDH)水平和肌酸激酶(CK)水平明显升高.2例患者均接受奥司他韦、糖皮质激素以及吸氧等对症支持治疗,其中1例间断接受无创通气.治疗后,临床症状缓解,胸部CT示实变影和磨玻璃影较入院时明显吸收.白细胞计数、LDH及CK水平恢复正常,复查咽拭子甲型H1N1流感病毒核酸阴性,康复出院.结论 部分甲型流感患者可合并肺炎,临床表现无特异性,胸部CT主要表现为双肺弥漫性分布的实变影及磨玻璃影;及时动态复查胸部CT对诊断和了解病情进展非常必要;糖皮质激素可缓解甲型流感合并肺炎患者咳嗽及气喘等症状,有助于肺部病变的吸收.     

Cytokine response in pediatric patients with pandemic influenza H1N1 2009 virus infection and pneumonia: comparison with pediatric pneumonia without H1N1 2009 infection

Objectives

We investigated serum cytokine levels in pediatric patients with pandemic influenza H1N1 2009 virus (H1N1) infection‐pneumonia and in pediatric patients with pneumonia but without H1N1 infection, and examined correlations between cytokine levels and clinical/laboratory findings.

Methods

Fifty‐seven cases of infection by H1N1 were confirmed by RT‐PCR and enrolled. Of these 57 cases, 26 had a severe H1N1 infection (group 1), and 31 had a mild H1N1 infection (group 2). Sera from 18 cases with pneumonia without H1N1 infection (group 3) were used as controls. The serum levels of 10 cytokines were determined by multiplex assay.

Results

The serum levels of IFN‐α, IL‐6, and IP‐10 were significantly higher in H1N1 infected cases than in group 3, and levels of IL‐6 and IP‐10 were significantly higher in group 1 than in group 2. The level of IL‐10 was significantly higher in groups 1 and 3 than in group 2. However, levels of IFN‐γ and IL‐17 were not significantly different between the three groups. IL‐1β, IL‐4, and MIP‐1α were not detectable in most patients. IP‐10 and IL‐6 levels were found to show negative correlations with lymphocyte count and oxygen saturation.

Conclusions

We found higher levels of cytokines (IFN‐α, IL‐6, IP‐10) of innate immunity than those of acquired immunity in pediatric H1N1 infection. Of the cytokines found to be increased in cases with H1N1 infection, IP‐10 and IL‐6 were found to be correlated with disease severity (lymphopenia and hypoxia). IP‐10 and IL‐6 may be important markers in pediatric H1N1 infection. Pediatr Pulmonol. 2011; 46: 1233–1239. © 2011 Wiley Periodicals, Inc.

     

重症甲型H1N1流行性感冒肺炎高分辨率计算机X线断层扫描表现的动态变化

目的 探讨重症甲型H1N1流行性感冒(流感)肺炎高分辨率计算机X线断层扫描(HRCT)表现及动态变化.方法 回顾性分析36例临床确诊的重症甲型H1N1流感肺炎1个月内100次HRCT资料,分析其肺部病变出现、进展及吸收时间和影像学特点.结果 发病初期行HRCT检查(3d内)6例,小片磨玻璃密度影3例,小片实变影3例.病变进展期(发病3d后)36例患者均表现为双肺多发弥漫分布的磨玻璃密度影伴或不伴实变,其中主要呈弥漫磨玻璃密度影9例,占25.0％；弥漫磨玻璃密度影伴实变影20例,占55.6％;主要呈肺实变影7例,占19.4％；合并胸膜病变10例,占27.8％.在发病(8.0±2.6)d内病变进展最为明显,发病(16.0±4.8)d后为吸收期,36例病变均明显吸收,23例出现肺间质增生,占63.9％.病灶的动态变化分三型,包括先进展后吸收型、进展和吸收并存后吸收型和逐渐吸收型,以先进展后吸收型为主,占41.7％.结论 HRCT可准确显示重症甲型H1N1流感肺炎的病变形态和范围,监测其动态变化.