摘要
目的分析探讨甲型H1N1流感确诊病例的影像学变化及其临床特点。方法回顾性分析河北省480例甲型H1N1流感确诊患者的临床特点及胸部影像学资料。结果本研究中患者以发热、咳嗽、咯痰等为主要表现。但随病情加重,尤其是危重症患者多见呼吸困难、紫绀、咯血、胸痛等,甚至会出现神经系统症状及意识障碍等。实验室检查提示,随着病情的加重,患者中性粒细胞比例升高,血清白蛋白水平下降,淋巴细胞比例下降,氧合指数下降等(P均<0.05)。普通型流感患者胸部影像学正常率高于重症及危重症组(P均<0.001),其中213例(80%)患者胸部多正常或无明显影像学征象,54例患者早期X线表现以肺间质改变为主。重症患者共108例,其中40例(37.0%)以局灶性实变影呈斑片状密度增高影为主,68例(63.0%)病变以肺间质浸润改变为主;危重症患者105例肺部病变重,且进展快,以肺实变、局限性或弥漫性斑片影为主要表现,其中70例(66.7%)患者发生急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS),30例(28.6%)发生双侧气胸,12例(11.4%)累及胸膜。在抗病毒治疗的基础上给予抗菌药物抗感染、糖皮质激素抗炎、氧疗、免疫调节及机械通气等辅助治疗。结论甲型流感重症及危重症病例影像学呈磨玻璃和实变密度的片状阴影改变,以双肺受累常见,主要分布于中下肺,肺野中外1/3及胸膜下。胸部影像学不但是诊断甲型H1N1流感的重要依据,也是监测其病情变化,评价治疗效果及预后的重要手段。
Objective To analyze and explore the imaging changes and clinical manifestations of patients with influenza A H1N1. Methods The clinical manifestations and chest imaging changes of 480 patients with influenza A （H1N1） in Hebei were analyzed, retrospectively. Results All patients involved mainly showed fever, cough and sputum. With the aggravation of the illness, dyspnea, cyanosis, hemoptysis, chest pain, neurological symptoms and disturbance of consciousness occurred, especially in critical patients. Laboratory examinations showed that the proportion of neutrophils increased, hut the serum albumin level, proportion of lymphocytes and oxygenation index decreased along with the aggravation of the disease （P 〈 0.05）. The chest imaging of patients suffering from the common type of influenza showed significantly higher normal frequency than the severe and critical cases （P 〈 0.001）, of which 213 cases （80%） were normal in chest imaging or without significantly different imaging signs, while changes in interstitial lung by early X-ray were found in 54 cases. Among 108 cases of severe illness, 40 cases mainly showed focal consolidation shadow with increased patchy density and 68 cases mainly showed interstitial infiltration; while the 105 critical patients were found severe and quick lung lesion with lung consolidation, local or diffuse patchy shadows as main imaging changes, among whom, 70 cases With acute lung injury/acute respiratory distress syndrome （ALI/ARDS）, 30 cases suffered from bilateral pneumothorax and 12 cases aroused the pleura illness. Based on the antiviral therapy, antibiotics and glucocorticoids were administrated respectively for anti-infection and antiinflammation, combined with oxygen therapy, immune regulation, mechanical ventilation and other adjuvant therapies. Conclusions The severe and critical cases of influenza A （H 1N 1） had imaging changes of ground-glass and consolidation density patchy shadows with common bilateral pulmonary involvement mainly distributed in the middle and lower lung, middle and 1/3 out of the lung field and lower pleura. Chest imaging is not only one important basis for the diagnosis of influenza A （H 1N 1）, but also an important means to monitor their condition changes, evaluate the therapeutic effect and prognosis.
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2013年第2期23-28,共6页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
