24例甲型H1N1流行性感冒病例报告

目的 研究24例甲型H1N1流行性感冒(简称流感)确诊患者的临床表现及实验室检查结果,并总结其特点.方法 分析总结了24例确诊患者流行病学资料、临床表现、实验室和影像学检查.并对患者T细胞亚群进行评价研究.结果 患者年龄从6岁至65岁,平均年龄26岁,年龄25岁以下15例.22例(22/24,91.7%)患者来自美国和加拿大疫区.常见症状和体征包括:发热22例(22/24,91.7%);咽痛22例(22/24,91.7%);咳嗽20例(20/24,83.3%),其中干咳14例(14/24,58.3%)、咯痰6例(6/24,25.0%);流涕6例(6/24,25.0%);头痛7例(7/24,29.2%);喷嚏、鼻塞各2例(2/24,8.3%);16例患者行CT检查,其中6例患者发现肺部炎症(6/16,37.5%);肌肉酸痛者4例(4/24,16.7%);腹泻者1例(1/24,4.2%);结膜炎1例(1/24,4.2%).实验室检查:检测CD4时,23例患者中18例降低(18/23,78.3%),其波动范围122～691细胞/μl(正常值为706～1125细胞/μl),平均值408细胞/μl.CD4/CD8比值仍在正常范围内.在治疗5～7 d后,14例患者复查CD4、CD8,其中CD4治疗前、后均值分别为(436.29±189.06)细胞/μl、(976.71±332.96)细胞/μl,配对t检验结果示:t=-5.416,P<0.05;CD8治疗前、后均值分别为(323.64±176.47)细胞/μl、(703.14±211.77)细胞/μl,配对t检验结果示:t=-5.319,P<0.05.22例患者测定了治疗前、后白细胞及淋巴细胞数值,白细胞治疗前为(5.13±1.47)×10~9/L,治疗后(6.25±1.37)×10~9/L,配对t检验结果示:t=-2.900,P<0.05;淋巴细胞治疗前(1.16±0.43)×10~9/L,治疗后(2.30±0.37)×10~9/L,配对t检验结果示:t=-6.819,P<0.05.治疗前、后白细胞、淋巴细胞、CD4、CD8比较,差异有统计学意义.CD4/CD8比值治疗前后分别为1.44±0.41、1.40±0.26,配对t检验结果示:t=0.507,P>0.05.二者之间差异无统计学意义.所有患者均应用达菲(奥司他韦,Oseltamivir)抗病毒治疗.患者病程在3-13 d之间,平均7.3 d,体温在起病后3～4 d均恢复正常,病毒核酸在1～10 d(平均4.5 d)阴转.结论 甲型H1N1病毒感染可引起以发热为常见的呼吸道疾患,具有自限性;病程中存在着T细胞亚群的变化,但目前尚无证据表明其变化可预测患者的病情预后.

Type A/H1N1 influenza: a clinical summary of 24 imported cases

Objective To study the clinical characteristics and laboratory results of 24 confirmed HI NI influenza cases. Methods The characters of clinical, laboratory, iconography and etiology of 24 patients with A/H1N1 were studied,and the changes of T-lymphocyte subsets that between the pre-and post-treatment were evaluated. Results The ages of patients were ranged from 6 to 65 years old; average age was 26 years old. 15 patients were under 25 years old. 22(22/24,91.7%) patients had recently traveled to USA or Canada. The most common presenting symptoms were: fever(22/24, 91.7%); sore throat (22/24, 91.7%); cough(20/24, 83.3%); dry cough (14/24, 58. 3%); expectoration (6/24, 25.0%); nasal discharge(6/24,25.0%). Six had pneumonia in sixteen patients (6/16,37.5%)who took CT scan; seven (7/24,29. 2%) had headache and four(4/24, 16. 7%) had muscular soreness; two(2/24,8. 3%) had sneeze and nasal obstruction; only one(1/24,4.2%) had diarrhea; one(1/24,4. 2%)had conjunctivitis.The result of 23 patients about T-Lymphocyte subsets: most of CD4 and CD8 were decreased (18/23, 78.3%), ranging from 122 to 691 cells/μl (normal was 706-1125 cells/μl),with the average of 408 cells/ μl,but ratios of CD4/CD8 were normal. Fourteen patients were detected CD4 and CD8 after received the treatment during 5 to 7 days. The results of CD4 (cells/μl) were different between the pre-and post-treatment: 436. 29±189. 06,976. 71±332. 96 (paired-samples t test: t=-5. 416, P < 0. 05) while the results of CD8 (cells/μl) were: 323. 64±176. 47,703.14±211.77 (t=-5.319, P < 0.05); the results of leukocytes in 22 patients were different between pre-and post-treatmet: (5.13±1.47)×10~9/L, (6. 25±1.37)×10~9/L(t=-2. 900, P < 0.05) while the results of lymphocytes were: (1.16±0. 43)×10~9/L, (2.30±0.37)×10~9/L (t=-6.819,P<0.05); but the ratios of CD4/CD8 were:1.44±0.41,1.40±0. 26 (t=0.507,P>0.05). All the patients were received antivirus treatment (Oseltamivir) and the virus conversed during 1-10 days(average 4. 5 days). The temperature was normal after onset during 3-4 days and the patients were recovered during 3-13 days(with the average of 7.3 days). Conclusion Influenza A virus H1N1 subtype was identified as the cause of outbreaks of febrile respiratory infection which was self-limited. There was no evidence to show that the changes of T-Lymphocyte subsets could indicate the prognosis of patients.