甲流H1N1流感病毒性肺炎临床特征及CT影像学表现分析
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摘要
目的探讨2019年1月至3月份凉山地区12例甲型H1N1流感病毒性肺炎患者治疗前后临床特征及CT影像学表现。方法选取2019年1月至3月于四川凉山地区某三甲医院呼吸内科收治的12例确诊的甲型H1N1流感病毒性肺炎患者为研究对象,对治疗前后的临床特征、实验室检查指标以及CT影像学结果进行分析。结果比较患者治疗前后白细胞、中性粒细胞、淋巴细胞以及血小板检测水平差异不具有统计学意义(P>0.05)。入组患者治疗前谷草转氨酶、总胆红素、直接胆红素、碱性磷酸酶及乳酸脱氢酶检测水平明显高于治疗后,差异具有统计学意义(P<0.05)。入组患者就诊时间超过5 d的占91.67%,发热超过38.5℃占91.67%,头疼、肌痛的患者占66.67%,气紧、咳嗽的患者占91.67%,咳白痰患者占50.00%,胸闷喘息患者占66.67%,紫绀患者占50.00%,咽红占66.67%,肺部湿啰音占75.00%。入组患者CT显示病变部位肺门病变占8.33%,周围病变占25%,胸膜下病变占8.33%,多发病变占58.33%,其中磨玻璃影占50.00%,片絮状影占75.00%,弥散实变影、广泛肺纤维化占25.00%,弥散结节影占16.67%,其病变占全肺面积<30%占16.67%,病变占全肺面积30至50%占33.33%,病变占全肺面积>50%占50.00%。结论甲型H1N1流感病毒性肺炎患者主要临床症状是发热、气紧,咳嗽症状轻微,其实验室指标白细胞水平正常,主要影像学表现为磨玻璃影、片絮状影以及弥散实变影、大部分患者预后良好,重症患者可遗留肺纤维化。
Objective To analyze the clinical features and CT imaging findings of 12 patients with influenza A virus( H1 N1) pneumoniain before and after treatment from January to March 2019 in Liangshan Second People's Hospital,Xichang,Sichuan Province,China. Methods Twelve patients with confirmed as influenza A viral pneumonia admitted to the Department of Respiratory Medicine of Liangshan Second People's Hospital from January to March 2019 in Liangshan District,Xichang,Sichuan Province,China,were enrolled as the subjects of this study. Their clinical features,laboratory examination indexes and CT imaging results were analyzed before and after treatment. Results There was no significant difference in the levels of leukocytes,neutrophils,lymphocytes and platelets before and after treatment( P>0.05). The levels of glutamic oxaloacetic transaminase,total bilirubin expression,direct bilirubin,alkaline phosphatase and lactate dehydrogenase were significantly higher before treatment than those after treatment( P<0.05). As a result,91.67% of the included patients received treatment for more than 5 days,91. 67% had a fever exceeding 38. 5 ℃,66. 67% had headache and myalgia,91. 67% had shortness of breath and cough,50. 00% had cough and white sputum,66.67% had wheezing & tightness in the chest,50.00% had purpura,66.67% had red pharynx,and 75.00%had moist rale in the lungs. CT findings showed pulmonary hilar lesions in 8.33% of the patients,peripheral lesions in 25%,subpleural lesions in 8.33%,and multiple lesions in 58.33%. Among them,the ground-glass shadow accounted for 50.00%,patch-flake shadow accounted for 75.00%,dispersive consolidation shadow and extensive pulmonary fibrosis accounted for 25.00%,diffuse nodular shadow accounted for 16.67%. The patients with the lesions <30% of the total lung area accounted for 16.67%,the patients with the lesions for 30%-50%of the total lung area accounted for 33. 33%,and the patients with the lesions > 50% of the total lung area accounted for 50. 00%. Conclusion The main clinical symptoms of the patients with influenza A( H1 N1)virus pneumonia are fever,shortness in breath,and mild cough. The white blood cells as the laboratory indicators are normal. The main imaging findings are ground-glass,patch-flake,and dispersive consolidation shadow. Most patients have a good prognosis,and severe patients may have pulmonary fibrosis.
Objective To analyze the clinical features and CT imaging findings of 12 patients with influenza A virus( H1 N1) pneumoniain before and after treatment from January to March 2019 in Liangshan Second People's Hospital,Xichang,Sichuan Province,China. Methods Twelve patients with confirmed as influenza A viral pneumonia admitted to the Department of Respiratory Medicine of Liangshan Second People's Hospital from January to March 2019 in Liangshan District,Xichang,Sichuan Province,China,were enrolled as the subjects of this study. Their clinical features,laboratory examination indexes and CT imaging results were analyzed before and after treatment. Results There was no significant difference in the levels of leukocytes,neutrophils,lymphocytes and platelets before and after treatment( P>0.05). The levels of glutamic oxaloacetic transaminase,total bilirubin expression,direct bilirubin,alkaline phosphatase and lactate dehydrogenase were significantly higher before treatment than those after treatment( P<0.05). As a result,91.67% of the included patients received treatment for more than 5 days,91. 67% had a fever exceeding 38. 5 ℃,66. 67% had headache and myalgia,91. 67% had shortness of breath and cough,50. 00% had cough and white sputum,66.67% had wheezing & tightness in the chest,50.00% had purpura,66.67% had red pharynx,and 75.00%had moist rale in the lungs. CT findings showed pulmonary hilar lesions in 8.33% of the patients,peripheral lesions in 25%,subpleural lesions in 8.33%,and multiple lesions in 58.33%. Among them,the ground-glass shadow accounted for 50.00%,patch-flake shadow accounted for 75.00%,dispersive consolidation shadow and extensive pulmonary fibrosis accounted for 25.00%,diffuse nodular shadow accounted for 16.67%. The patients with the lesions <30% of the total lung area accounted for 16.67%,the patients with the lesions for 30%-50%of the total lung area accounted for 33. 33%,and the patients with the lesions > 50% of the total lung area accounted for 50. 00%. Conclusion The main clinical symptoms of the patients with influenza A( H1 N1)virus pneumonia are fever,shortness in breath,and mild cough. The white blood cells as the laboratory indicators are normal. The main imaging findings are ground-glass,patch-flake,and dispersive consolidation shadow. Most patients have a good prognosis,and severe patients may have pulmonary fibrosis.
引文
1鲁福文.重症甲流感病毒肺炎影像学表现[J].甘肃科技,2017,33(05):111-112.
2 Koo HJ,Lim S,Choe J,et al.Radiographic and CT features of viral pneumonia[J].Radiographics,2018,38(3):719-739.
3王丹,王瑾,赵丽,等.重症甲流患儿的临床特点及诊疗体会[J/CD].临床检验杂志(电子版),2017,6(2):159-160.
4 Chung JH,Montner SM,Adegunsoye A,et al.CT findings,radiologicpathologic correlation,and imaging predictors of survival for patients with interstitial pneumonia with autoimmune features[J].AJR Am JRoentgenol,2017,208(6):1229-1236.
5朱芮,甘雨茹,盛鄂湘,等.武汉市某医院2016-2017年流行性感冒流行病学与临床特征分析[J].武汉大学学报(医学版),2018,39(4):33.
6 Upchurch CP,Grijalva CG,Wunderink RG,et al.Community-acquired pneumonia visualized on CT scans but not chest radiographs:pathogens,severity,and clinical outcomes[J].Chest,2017,153(3):601-610.
7吉茂礼,程涛.甲型H1N1流感病毒RNA定量分析在轻型与肺炎患者中的应用[J].陕西医学杂志,2018,47(11):137-140.
8 Seo H,Cha SI,Shin KM,et al.Relationship between clinical features and computed tomographic findings in hospitalized adult patients with community-acquired pneumonia[J].Am J Med Sci,2018,356(1):30-38.
9田原,戴胜归,施耀勇,等.甲型H1N1流感防控技术指南[M].兰州大学出版社,2010:33.
10李娟,赵苗苗,马雪瀛,等.流行性感冒发病初期利用流式细胞仪检测相关细胞因子的临床应用价值探讨[J].国际检验医学杂志,2017(24):3396-3397.
11杨厚宇,王旻晋,梁宗安.呼吸道病毒核酸检测结果分析[J].四川医学,2017(04):61-66.
12 Park JY,Kim BJ,Lee EJ,et al.Clinical features and courses of adenovirus pneumonia in healthy young adults during an outbreak among Korean military personnel[J].Plos One,2017,12(1):e0170592.
13武涧松,原杰,贺婷婷,等.流感暴发期间5 447例成人流感样病例的流感病毒检测结果与分布特征[J].中华医院感染学杂志,2018,28(23):10-15.
14 Li H,Weng H,Lan C,et al.Comparison of patients with avian influenza A(H7N9)and influenza A(H1N1)complicated by acute respiratory distress syndrome[J].Medicine,2018,97(12):e0194.
15傅利民.桔贝合剂辅助治疗小儿病毒性肺炎效果观察[J].山东医药,2018(2):57-59.
16 Hammer MM,Gosangi B,Hatabu H.Human herpesvirus alpha subfamily(Herpes Simplex and Varicella Zoster)viral pneumonias:CTfindings[J].J Thorac Imaging,2018,33(6):384-389.
17陈远彬,何冰,林琳,等.流感双解方治疗轻型流感病毒性肺炎26例临床观察[J].中医杂志,2017,58(2):128-132.
18 Dettmer S,Grünwald V,Fuehner T,et al.CT patterns of organizing pneumonia in patients treated with VEGF/m TOR inhibitors for metastatic renal cell cancer:an observational study[J].Acta Radiologica Open,2017,6(2):2058460117694216.
19郝欧美,王雪峰,魏巍,等.中医内外合治综合方案改善小儿病毒性肺炎中医证候的多中心随机对照研究[J].中华中医药杂志,2017(11):442-446.
20 Ailing L,Ning X,Tao Q,et al.Successful treatment of suspected organizing pneumonia in a patient without typical imaging and pathological characteristic:A case report[J].Respir Med Case Rep,2017,22:246-250.
22 Torrealba JR,Fisher S,Kanne JP,et al.Pathology-radiology correlation of common and uncommon computed tomographic patterns of organizing pneumonia[J].Hum Pathol,2018,71:30-40.
22 Feinstein MB,De Souza SA,Moreira AL,et al.A comparison of the pathological,clinical and radiographical,features of cryptogenic organising pneumonia,acute fibrinous and organising pneumonia and granulomatous organising pneumonia[J].J Clin Pathol,2015,68(6):441-447.
23 Zhang Y,Sakthivel SK,Bramley A,et al.Serology enhances molecular diagnosis of respiratory virus infections other than influenza in children and adults ospitalized with community-acquired pneumonia[J].J Clin Microbiol,2017,55(1):79-89.
24钱永兵,谢晖,田锐,等.早期免疫功能麻痹在重症甲型H1N1流感中的临床意义[J].中华危重病急救医学,2017,29(7):581-585.
25 Borgogna TR,Hisey B,Heitmann E,et al.Secondary bacterial pneumonia by staphylococcus aureus following influenza a infection is SaeR/S dependent[J].J Infect Dis,2018,58(2):809-813.
26刘红,徐瑞芳.磷酸奥司他韦联合抗病毒口服液治疗甲型H1N1流感的临床观察[J].中国中医急症,2017,26(8):1474-1476.
27 Wonderlich ER,Swan ZD,Bissel SJ,et al.Widespread Virus Replication in Alveoli Drives Acute Respiratory Distress Syndrome in Aerosolized H5N1 Influenza Infection of Macaques[J].JImmunol,2017,198(4):1616-1626.
28吉茂礼,程涛.甲型H1N1流感病毒RNA定量分析在轻型与肺炎患者中的应用[J].陕西医学杂志,2018,47(11):137-140.
29 Kondo K,Suzuki K,Washio M,et al.Effectiveness of 23-valent pneumococcal polysaccharide vaccine and seasonal influenza vaccine for pneumonia among the elderly-Selection of controls in a casecontrol study[J].Vaccine,2017,35(36):4806-4810.
30李明,苏维,马士恒,等.甲型H1N1型流感患者外周血程序化细胞死亡分子5表达水平及其与疾病严重程度的相关性[J].医学研究生学报,2018,31(6):33.
2 Koo HJ,Lim S,Choe J,et al.Radiographic and CT features of viral pneumonia[J].Radiographics,2018,38(3):719-739.
3王丹,王瑾,赵丽,等.重症甲流患儿的临床特点及诊疗体会[J/CD].临床检验杂志(电子版),2017,6(2):159-160.
4 Chung JH,Montner SM,Adegunsoye A,et al.CT findings,radiologicpathologic correlation,and imaging predictors of survival for patients with interstitial pneumonia with autoimmune features[J].AJR Am JRoentgenol,2017,208(6):1229-1236.
5朱芮,甘雨茹,盛鄂湘,等.武汉市某医院2016-2017年流行性感冒流行病学与临床特征分析[J].武汉大学学报(医学版),2018,39(4):33.
6 Upchurch CP,Grijalva CG,Wunderink RG,et al.Community-acquired pneumonia visualized on CT scans but not chest radiographs:pathogens,severity,and clinical outcomes[J].Chest,2017,153(3):601-610.
7吉茂礼,程涛.甲型H1N1流感病毒RNA定量分析在轻型与肺炎患者中的应用[J].陕西医学杂志,2018,47(11):137-140.
8 Seo H,Cha SI,Shin KM,et al.Relationship between clinical features and computed tomographic findings in hospitalized adult patients with community-acquired pneumonia[J].Am J Med Sci,2018,356(1):30-38.
9田原,戴胜归,施耀勇,等.甲型H1N1流感防控技术指南[M].兰州大学出版社,2010:33.
10李娟,赵苗苗,马雪瀛,等.流行性感冒发病初期利用流式细胞仪检测相关细胞因子的临床应用价值探讨[J].国际检验医学杂志,2017(24):3396-3397.
11杨厚宇,王旻晋,梁宗安.呼吸道病毒核酸检测结果分析[J].四川医学,2017(04):61-66.
12 Park JY,Kim BJ,Lee EJ,et al.Clinical features and courses of adenovirus pneumonia in healthy young adults during an outbreak among Korean military personnel[J].Plos One,2017,12(1):e0170592.
13武涧松,原杰,贺婷婷,等.流感暴发期间5 447例成人流感样病例的流感病毒检测结果与分布特征[J].中华医院感染学杂志,2018,28(23):10-15.
14 Li H,Weng H,Lan C,et al.Comparison of patients with avian influenza A(H7N9)and influenza A(H1N1)complicated by acute respiratory distress syndrome[J].Medicine,2018,97(12):e0194.
15傅利民.桔贝合剂辅助治疗小儿病毒性肺炎效果观察[J].山东医药,2018(2):57-59.
16 Hammer MM,Gosangi B,Hatabu H.Human herpesvirus alpha subfamily(Herpes Simplex and Varicella Zoster)viral pneumonias:CTfindings[J].J Thorac Imaging,2018,33(6):384-389.
17陈远彬,何冰,林琳,等.流感双解方治疗轻型流感病毒性肺炎26例临床观察[J].中医杂志,2017,58(2):128-132.
18 Dettmer S,Grünwald V,Fuehner T,et al.CT patterns of organizing pneumonia in patients treated with VEGF/m TOR inhibitors for metastatic renal cell cancer:an observational study[J].Acta Radiologica Open,2017,6(2):2058460117694216.
19郝欧美,王雪峰,魏巍,等.中医内外合治综合方案改善小儿病毒性肺炎中医证候的多中心随机对照研究[J].中华中医药杂志,2017(11):442-446.
20 Ailing L,Ning X,Tao Q,et al.Successful treatment of suspected organizing pneumonia in a patient without typical imaging and pathological characteristic:A case report[J].Respir Med Case Rep,2017,22:246-250.
22 Torrealba JR,Fisher S,Kanne JP,et al.Pathology-radiology correlation of common and uncommon computed tomographic patterns of organizing pneumonia[J].Hum Pathol,2018,71:30-40.
22 Feinstein MB,De Souza SA,Moreira AL,et al.A comparison of the pathological,clinical and radiographical,features of cryptogenic organising pneumonia,acute fibrinous and organising pneumonia and granulomatous organising pneumonia[J].J Clin Pathol,2015,68(6):441-447.
23 Zhang Y,Sakthivel SK,Bramley A,et al.Serology enhances molecular diagnosis of respiratory virus infections other than influenza in children and adults ospitalized with community-acquired pneumonia[J].J Clin Microbiol,2017,55(1):79-89.
24钱永兵,谢晖,田锐,等.早期免疫功能麻痹在重症甲型H1N1流感中的临床意义[J].中华危重病急救医学,2017,29(7):581-585.
25 Borgogna TR,Hisey B,Heitmann E,et al.Secondary bacterial pneumonia by staphylococcus aureus following influenza a infection is SaeR/S dependent[J].J Infect Dis,2018,58(2):809-813.
26刘红,徐瑞芳.磷酸奥司他韦联合抗病毒口服液治疗甲型H1N1流感的临床观察[J].中国中医急症,2017,26(8):1474-1476.
27 Wonderlich ER,Swan ZD,Bissel SJ,et al.Widespread Virus Replication in Alveoli Drives Acute Respiratory Distress Syndrome in Aerosolized H5N1 Influenza Infection of Macaques[J].JImmunol,2017,198(4):1616-1626.
28吉茂礼,程涛.甲型H1N1流感病毒RNA定量分析在轻型与肺炎患者中的应用[J].陕西医学杂志,2018,47(11):137-140.
29 Kondo K,Suzuki K,Washio M,et al.Effectiveness of 23-valent pneumococcal polysaccharide vaccine and seasonal influenza vaccine for pneumonia among the elderly-Selection of controls in a casecontrol study[J].Vaccine,2017,35(36):4806-4810.
30李明,苏维,马士恒,等.甲型H1N1型流感患者外周血程序化细胞死亡分子5表达水平及其与疾病严重程度的相关性[J].医学研究生学报,2018,31(6):33.