甲型H1N1流感合并肺炎39例临床分析

目的分析甲型H1N1流感合并肺炎患者的临床特点,探讨其诊断和救治方法。方法对中国医科大学附属盛京医院急诊科确诊的39例甲型H1N1流感合并肺炎患者的流行病学资料、临床表现、实验室检查、胸部X线或肺部CT表现进行回顾性分析。结果39例甲型H1N1流感合并肺炎患者中,男17例,女22例;18—59岁36例（92．31％）。流行病学资料显示,39例患者均无明确的与发病期甲型H1N1流感确诊病例密切接触史。临床症状有发热（100％）、咳嗽（58．97％）、咽痛（38．46％）、乏力（28．21％）等。实验室检查：血白细胞计数正常或低于正常28例（71．79％）,心肌酶谱异常主要表现为肌酸激酶升高（58．97％）,肝功能异常主要表现为天冬氨酸氨基转氨酶升高（43．59％）,重症患者血气分析提示急性肺损伤（12．82％）。胸部X线或肺部CT表现为从散在多叶或段炎症到单侧肺或双侧肺内中带可见大片状高密度影。结论有发热症状,肺炎影像学短时间内动态改变并迅速恶化,动脉血气分析迅速表现出低氧血症,肌酸激酶和天冬氨酸氨基转氨酶升高时,要高度疑诊甲型H1N1流感重症病例,经甲型H1N1流感病毒核酸检测可诊断为甲型H1N1流感合并肺炎病例。奥司他韦为首选抗病毒药,给予综合支持对症治疗,早期氧疗、尽早使用呼吸机治疗是降低甲型H1N1流感合并肺炎危重病例病死率的关键。     

11例儿童甲型H1N1流感重症病例的临床分析

目的:描述甲型H1N1重症流感患儿的临床症状特点.方法:对我院2009年11月～2010年1月共收治11例甲型H1N1重症流感患儿,进行回顾性研究,了解临床特征及为临床诊治提供一定的经验.结果:11例患儿中,男性8例,女性3例,年龄分布从2岁1月到8岁5月,起病症状均为咳嗽、发热、咳痰,所有病例均有胸片肺部感染病变,采取特异性治疗后均痊愈出院.结论:儿童甲型H1N1流感重症病例起病年龄及症状不典型,可能合并细菌感染,予抗病毒药物治疗等综合治疗,可取得较好疗效.     

335例甲型H1N1流感病例流行病学分析

目的 探讨甲型H1N1流感的流行病学特征.方法 回顾性分析2009年6月至2010年1月确诊的335例甲型H1N1流感患者的流行病学资料,分析普通型与危-重型患者的流行病学特点.结果 2009年10月前患者多有甲型H1N1流感接触史,病情轻;2009年11月至2010年1月患者少有甲型H1N1流感接触史,危-重型患者增...     

30例甲型H1N1流感肺炎病例的临床分析

目的 分析甲型H1N1流感肺炎病例的临床特点.方法 回顾性分析30例甲型H1N1流感肺炎患者的临床资料.结果 患者男女比例相当,年龄 17～54 岁,23.3%有慢性疾病史,26.7%为孕产妇,病死率为13.4%.重症与轻症患者比较,其呼吸困难、再次发热、X线胸片病变程度、淋巴细胞计数、动脉血气分析、C反应蛋白、心肌酶...     

甲型H1N1流感确诊病例临床特点和治疗研究

目的分析甲型H1N1流感确诊病例的临床特征,探讨治疗方法,为防治提供依据。方法对229例甲型H1N1流感确诊病例的一般情况,临床表现,实验室检查,胸部X线,治疗方法进行统计、分析。结果甲型H1N1流感确诊病例平均年龄18.12岁,男：女为3.09：1,临床症状、体征中前三位分别是咳嗽157例、咽痛135例、咳痰50例和发热228例、咽部充血225例。白细胞总数降低40例、中性粒细胞和淋巴细胞降低占多数。血清酶升高：ALT22例、AST29例、LDH26例、CK45例、CKMB8例,血脂降低：CHO83例、TG108例。胸部X线异常6例,单侧肺炎1例,双侧肺炎5例。中药使用率100%,达菲使用率35.80%,抗生素使用率16.59%,其它抗病毒药物使用率13.10%。平均住院5.21d。结论甲型H1N1流感确诊病例以咳嗽、咽痛、咳痰、发热、咽部充血和肺部病变居多,CT检出肺部病变多,绝大部分血白细胞降低,心肌和肝脏最易受侵害,药物治疗效果好,病程较短。     

重症甲型H1N1流感肺炎的影像学表现

目的探讨重症甲型H1N1流感肺炎的影像学表现。方法对经确诊的29例重症甲型H1N1流感肺炎的胸部X线表现及CT表现进行回顾性分析。结果重症甲型H1N1流感肺炎的胸部X线表现为两肺野斑片状密度增高的实变影16例,磨玻璃样阴影11例,两肺间质改变、肺纹理增粗2例。结论重症甲型H1N1流感肺炎主要的胸部影像学表现为两肺支气管周围和胸膜下非对称性、多发斑片状实变影及磨玻璃样阴影。     

甲型H1N1流感病例187例临床分析

目的探讨甲型H1N1流感主要的临床表现,分析早期症状与发生重症流感的相关性。方法回顾性分析2009年5—10月我院确诊的甲型H1N1流感住院病例187例,符合重症标准的30例（胸部X线片提示肺炎）,157例普通型,不包括危重症病例。结果 187例患者的平均年龄为（20.61±13.87）岁;男女比例98：89。最常见的症状和体征为发热（90.9%）和咳嗽（78.6%）以及咽部充血（80.2%）和扁桃体肿大（65.2%）。所有患者的症状体征均于15d内消失,平均（5.01±2.39）d。发热持续时间平均（3.56±1.96）d。甲型H1N1流感病毒核酸阳性持续时间平均（5.51±2.29）d。肺炎发生独立危险因素包括出现气促、症状持续时间超过7d。结论甲型H1N1流感临床症状类似季节性流感,多数病例为自限性、轻症病例,出现气促并且症状持续超过7d提示可能为重症病例。     

危重症甲型H1N1流感病例临床分析

目的通过回顾性分析24例危重症甲型H1N1流感病例的特点,提高对该病危重症病例认识、诊断及治疗水平。方法对24例甲型H1N1流感危重症病例临床资料进行回顾性分析。分析该病危重症患者的一般临床表现、影像学改变、实验室检查等相关资料,提高甲型H1N1流感危重症病人早期诊断。结果 24例患者均为甲型H1N1流感危重症患者,男性10例,女性14例(其中孕妇3例,产妇1例),平均年龄(39.25±18.57)岁。其中7例患者存在基础疾病,4例患者为术后病人。14例患者经复查咽拭子,甲型H1N1病毒核酸检测转阴时间为(12.4±5.7)天。经治疗,17例患者症状改善时间平均为(11.2±12.1)天。24例患者中14例存在ARDS,22例患者伴有不同程度的肺水肿,2例患者出现多脏器功能衰竭,2例患者出现脓毒症。24例患者中除5例患者放弃治疗外,有3例(15.8%)死亡。结论大多数危重症患者就诊时流感样症状均不典型,临床表现及理化检查差异性较大,容易出现漏诊误诊。多数病人存在不同程度的ARDS、肺水肿,进展快,死亡率较高。     

甲型H1N1流感重症病例临床及肺部影像特征分析(附3例报告)

目的提高对甲型H1N1流感重症病例肺部影像特征认识。方法分析3例甲型H1N1流感重症病例的临床资料,并对其肺部影像学特征进行分析。结果 3例病人胸部CT显示不同程度肺损伤。例1胸部CT表现左侧肺部中、下叶大片渗出性致密阴影,右肺下叶可见少许渗出性阴影,边界不规则。例2胸部CT表现为右侧肺下叶渗出性阴影,散在性多发病灶。例3胸部CT表现为双侧肺上中下渗出性病灶,以中下叶为主。3例临床均表现为发热、咳嗽和胸闷症状,低氧血症以及白细胞减少。3例均给予抗生素和奥司他韦治疗,效果良好,康复出院。结论甲型H1N1流感重症病例肺部影像表现为以双侧中下叶为主的多发病灶,以渗出性阴影为主,间或少许间质改变,病灶呈多样性变化为特点,进展迅速。抗炎抗病毒治疗后吸收良好。     

甲型H1N1流感重症病例5例临床特点及预后分析

目的分析甲型H1N1流感重症病例的临床特点及预后,总结医疗救治经验。方法对2009年10月28日至12月31日我院收治的甲型H1N1流感重症住院的5例患者临床资料进行回顾性分析。结果 5例患者确诊后即给予奥司他韦胶囊口服,75mg/次,2次/d,疗程5d,同时辅以中药如香菊胶囊或莲花清瘟胶囊口服治疗;糖皮质激素主要为氢化可的松,100～150mg/d。5例全部治愈,预后良好。结论重症的早期识别是甲型H1N1流感诊治的关键,给予奥司他韦抗病毒治疗及综合支持治疗,疗效满意。     

Sixty-two severe and critical patients with 2009 influenza A (H1N1) in Shanghai, China

Background  Pandemic influenza A (H1N1) emerged rapidly in China in May 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A (H1N1) disproportionately affects younger ages and causes generally mild disease. To characterize disease progress, comorbidities, and treatment outcomes among consecutive severe and critically ill patients in a hospital served as a reference center for the care of patients with H1N1 in Shanghai, China.

Methods  A retrospective study on 62 severe and critically ill patients with 2009 influenza A (H1N1) was conducted in Shanghai Public Health Clinical Center. Demographic data, symptoms, comorbidities, disease progression, treatments, and clinical outcomes were collected for analysis.

Results  Sixty-two severe or critically ill patients were admitted to the hospital with confirmed 2009 influenza A (H1N1) infection. The median age of the study cohort was 40 years old with a range from 18 years to 75 years, and 67.7% were males. All patients presented with fever and respiratory symptoms. At presentation, 34 patients (54.8%) had comorbidities such as smoking (29.0%), hypertension (29.0%) and hepatitis B virus infection (9.7%). The median time from symptom onset to hospital admission was 6 days (interquartile-range 3–14 days) and 23 critically ill patients were admitted to Intensive Care Unit after admission. All the patients received neuraminidase inhibitors (oseltaminir), while 60 patients (96.7%) were treated with antibiotics, and 39 (62.9%) with corticosteroids. Twenty-three critical cases received noninvasive mechanical ventilation on the first day of admission, and 3 of them ultimately required invasive ventilation. Four death reports (6.5%) were filed within the first 14 days from the onset of critical illness with the primary causes of severe acute respiratory distress syndrome, hypoxemia, or complications, secondary infection and sepsis, pyopneumothorax and stroke.

Conclusions  Severe illness from 2009 influenza A (H1N1) infection in Shanghai occurred among young individuals. Critical cases were associated with severe hypoxemia, multisystem organ failure, and a requirement for mechanical ventilation. Most patients had a good prognosis.

     

Hospitalized patients with novel influenza A (H1N1) virus infection: Shanghai, June–July 2009

Background From late May 2009, sporadic imported cases of novel influenza A （HIN1） were continuously confirmed in Shanghai, but there were few reports on its clinical presentation in China. The aim of the study was to investigate the demographic and clinical features of the laboratory-confirmed cases and the treatment with oseltamivir. Method We performed a retrospective study in the Shanghai Public Health Clinical Center （SHAPHC）, reviewing the medical records of the laboratory-confirmed patients derived from June 10 to July 20, 2009. Results A total of 156 cases were enrolled, of whom 152 had a history of recent travel. The mean age was 22.6 years and 89 cases （57.1%） were males. The most common symptoms were fever, cough, and sore throat, with children more likely to run a temperature above 38.5℃ than adults. The mean leucocyte count was 5.4×10^9/L, the mean neutrophil count 3.2×10^9/L and the mean lymphocyte count 1.4×10^9/L. Other findings included a normal range or elevated level of C-reactive protein （CRP） and glutamic-pyruvic transaminase and a normal or decreased level of prealbumin; the levels of prealbumin and CRP were significantly lower in the children than in the adults. Fifty-two patients had abnormal chest CT results, with small unilateral or bilateral pulmonary infiltrates, axillary and mediastinal lymphadenopathy and local pleural thickening, while no cases showed symptoms of hypoxia. All the patients received oseltamivir and recovered without complications, but the duration of fever and virus shedding were significantly longer in the children than in the adults. Conclusions Travel-related circulation may be an important reason for the H1N1 epidemic in the non-epidemic areas, and the virus caused mild respiratory symptoms. The infection in children was more severe in terms of prealbumin levels, temperature, the duration of fever and virus shedding. Oseltamivir was effective for H1N1, but more effective in the adults than in the children.     

24例甲型H1N1流感并发重症肺炎患者的临床分析

目的：探讨新型病原体甲型H1N1流感病毒所致危重患者的临床特征,为判断病情和治疗提供参考。方法：对24例甲型H1N1流感并发重症肺炎患者的一般临床资料、症状、体征、辅助检查、诊断及治疗方法和结果进行分析。结果：24例患者平均年龄（28.73±9.24)岁,其中孕妇2例（8.3%）,肥胖［体质指数（BMI）≥30］18例(75%),有慢性基础疾病者2例（8.3%）,包括支气管哮喘1例,肾移植术后1例。患者以发热、咽痛、气短为主要症状。双肺多发实变20例（83.3%）。24例患者均给予抗病毒治疗（奥司他韦75 mg或150 mg每日2次口服）,其中22例（91.6%）患者应用激素治疗,18例（75.0%）患者采用机械通气治疗,6例(25.0%)患者经气管插管行机械通气治疗,2例（8.3%）患者死亡。结论：甲型H1N1流感并发重症肺炎患者以青壮年为主,孕妇、肥胖、有慢性基础疾病者感染后易并发重症肺炎,应尽早应用抗病毒药物、合理应用糖皮质激素和人工通气辅助治疗,张力性气胸、多脏器功能不全等相关并发症是其主要死亡原因。     

Influenza A pandemic (H1N1) 2009 virus infection

The clinical spectrum of the 2009 pandemic influenza A (H1N1) infection ranged from self-limited mild illness to progressive pneumonia, or even a fatal outcome. We summarize the clinical manifestations, risk factors for severe and fatal cases, pathologic findings and treatment of this disease in this paper based on current reports from different regions of the world.

     

金刚烷胺修饰物抗禽流感病毒的作用机制

目的：初步探讨金刚烷胺修饰物（NAM）抗禽流感病毒的作用机制,为抗禽流感病毒新药NAM的开发提供实验依据。方法：对狗肾细胞（MDCK）进行体外培养,分为正常对照组,病毒对照组和受试物组。①采用细胞病变法结合MTT法检测NAM对禽流感病毒（H5N1）的抑制作用,受试物组分为先加入NAM后感染病毒、先感染病毒后加入NAM和感染病毒的同时加入NAM,观察3种方式NAM对禽流感病毒的半数抑制浓度(IC50)和治疗指数(TI);②采用神经氨酸酶抑制实验检测NAM对神经氨酸酶的活性影响。结果：① 3种不同的实验方式NAM剂量对数与细胞保护率均呈正相关关系（r 分别为0.95、0.95和0.99,P均<0.05）,且NAM与保护率存在量效依赖关系。先加入NAM后感染病毒,NAM的IC50为15.32 mg·L-1,TI为103.31;先感染病毒后加入NAM,NAM的IC50为30.78 mg·L-1,TI为28.10;感染病毒的同时加入NAM,NAM的IC50为203.92 mg·L^-1,TI为4.24。②NAM具有一定的流感病毒神经氨酸酶抑制活性,其IC50为87.36 mg·L^-1。结论：NAM对穿入细胞后的禽流感病毒有较好的抑制作用,同时干扰病毒吸附和侵入细胞的脱壳过程也有一定的作用,能够在一定程度上抑制病毒的神经氨酸酶活性。     

Influenza A (H1N1) pneumonia: an analysis of 63 cases by chest CT

Background  In early April 2009, cases of human infection with 2009 pandemic influenza A (H1N1) virus were identified in Mexico. The virus then spread rapidly to other regions of the world. From October 2009, sporadic imported cases of novel influenza A (H1N1) were continuously confirmed in Suzhou. The aim of the study was to review the chest CT findings in 63 patients with laboratory-confirmed novel swine-origin influenza A (H1N1) virus (S-OIV) infection.

Methods  Chest CT examinations were collected from 63 S-OIV infected patients during their hospital stay. Three experienced radiologists inspected images to qualitatively and quantitatively characterize S-OIV induced image changes. CT scores of lesion severity were calculated based on the percentage of affected area to determine severity of infectious lesions. Patients were divided into two groups based on the leukocyte counts. Lesion patterns, local distributions, and quantitative measures were investigated and compared between the two groups.

Results  Various degrees of bilateral multifocal lesions of ground-glass opacities were found with or without consolidations on the chest CT images. The lesions were both bronchocentric and centrilobular. Patients with elevated leukocyte counts had more extensive lesions, in terms of severity and affected area, than the patients with normal leukocyte counts. The lesion severity scores of patients in the elevated leukocyte group were significantly higher than those of the normal leukocyte group in terms of the entire lung area (P <0.01), and upper (P <0.05) and lower (P <0.01) lobes as well. There were changes in the CT characteristics seen at follow-up as demonstrated by lesions absorption (P <0.01), especially in the upper lobe of the lung (P <0.01), but less so in the middle lobe/lingual and lower lobe of the lung (P >0.05).

Conclusions  The most common CT findings in S-OIV infection patients were bilateral multifocal distributed ground-glass opacities and consolidations. The lesions were located dominantly at bronchocentric and centrilobular areas. Lung lesions were more obviously absorbed in upper lobes between two examinations. The observations and analysis from this study provide information that may be useful in image understanding and patient management for future pandemic influenza.

     

甲型H1N1流感肺炎胸部CT表现

目的探讨甲流相关肺炎胸部CT表现特征,提高对该疾病的影像学认识。方法回顾分析41例甲流相关肺炎胸部CT特征。结果甲流肺炎的胸部CT病变形态包括磨玻璃状阴影（n=37,90%）,实变（n=12,29%）,单侧肺受累（n=6,15%）,双肺受累（n=35,85%）,主要分布于中下肺（n=37,90%）,肺野中外1/3及胸膜下（n=39,95%）。没有发现肺门或纵膈淋巴结肿大患者。结论甲型H1N1流感肺炎胸部CT以磨玻璃阴影及实变为主,单或双侧中下肺多见,主要累及肺野中外1/3及胸膜下。     

甲型H1N1流行性感冒普通型与重型患者临床特征分析

采用描述性流行病学方法对确诊的150例普通甲型流行性感冒和38例重型甲型流行性感冒患者的临床资料进行回顾性分析.普通型患者主要表现为季节性流感样症状,并发症少,重型患者的症状则以持续高热、咳血痰、气促、呼吸困难为主,并可出现呼吸衰竭、急性呼吸窘迫综合征等并发症.重型患者肥胖及存在基础疾病的比率明显高于普通型,差异具有统计学意义（P＜0.05）,肥胖及有基础疾病者是重型甲型流行性感冒的高危人群.普通型患者均治愈出院,病程5～11 d;重型中34例症状好转出院,4例死亡,病死率10.5%。     

甲型H1N1流感重症患者的临床及影像学特点

目的 探讨甲型H1N1流感（甲流）危重症病例的影像学特征及其临床特点。方法 上海交通大学医学院附属瑞金医院2009年12月—2010年2月共收治13例重症甲流确诊患者,其中男性10例,女性3例;年龄24~59岁,中位年龄50岁。回顾性分析患者的临床症状、实验室检查结果、影像学资料、治疗措施及预后。结果 所有患者均以发热、咳嗽为主要症状。实验室表现为白细胞数量下降,尤其是淋巴细胞数量减少,乳酸脱氢酶（LDH）水平升高。胸部X线片及CT检查主要表现为两肺多发散在斑点或团片状模糊影,部分可融合呈大片状实变影。予以抗病毒、糖皮质激素、抗生素等综合支持治疗后,11例好转,1例并发真菌感染,1例死亡。结论 甲流危重病例的影像学表现为肺叶或间质炎症浸润,病情重、进展快,可导致死亡,早期识别并及时给予积极治疗可取得较好的疗效。