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.

Report of 2 cases of novel influenza A (H1N1) virus infection complicated with pneumonia and Hypoxemia

Objective To improve understanding of the novel influenza A (H1N1) virus infection complicated with pneumonia. Method Clinical presentations, radiological data, laboratory data and treatments of 2 patients with pneumonia caused by the novel influenza A (H1N1) virus were retrospectively analyzed. Results One patient was a middle-aged woman, and the other was a young man with a history of asthma. Both patients had fever (temperatures more than 39℃), cough, and dyspnea. At the time of admission, both patients had hypoxemia. Chest computed tomography (CT) scan showed patchy distribution of consolidation and ground-glass opacity mainly in peripheral subpleural regions, as well as peribrochovascular lesions with air-bronchogram. The decreased and lymphocytes, elevated lactate dehydrogenase and creatine kinase were found in both patients. After admission, the patients received oseltamivir with a dose of 75 mg twice a day for a minimum of 5 days. Other treatments included antibiotics and methylprednisolone. One patient needed intermittent non-invasive ventilation for respiratory distress. Both patients recovered and the opacities on their chest CT were almost absorbed. WBC counts increased to normal and the levels of LDH and CK decreased. Conclusions Patients with the novel influenza A (H1N1) virus infection may develop pneumonia. The manifestations are non-specific. Chest CT scan reveals patchy distribution of consolidation and ground-glass opacity. In addition to antiviral therapy, glucocorticoids may have some effects on the pulmonary lesions and be useful for improving the clinical conditions.