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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2019, Vol. 12 ›› Issue (03) : 296 -300. doi: 10.3877/cma.j.issn.1674-6902.2019.03.006

所属专题： 文献；

论著

甲流H1N1流感病毒性肺炎临床特征及CT影像学表现分析
杜娟1,†(), 范学杰2, 陈红梅3, 蒋飞4   
  1. 1. 615000　西昌，凉山州第二人民医院呼吸内科
    2. 610000　成都，四川省军区第十二离职干部休养所门诊部
    3. 638500　广安，四川大学华西广安医院呼吸内科
    4. 615000　西昌，凉山州第二人民医院放射科
  • 收稿日期:2019-01-17 出版日期:2019-06-20
  • 通信作者: 杜娟
  • 基金资助:
    四川省科技厅基金资助项目(2015RZ10460)

Clinical features and CT imaging features of patients with influenza A H1N1 virus pneumonia

juan Du1,†(), Xuejie Fan2, Hongmei Chen3, Fei Jiang4   

  1. 1. Department of Respiratory Medicine, Liangshan Second People′s Hospital, Xichang 615000, China
    2. Department of Respiratory Medicine, Guang′an Hospital, Sichuan University, Guang′an 638500, China
    3. Outpatient Department, 12th Retired Cadres Sanatorium of Sichuan Military Command, Chengdu 610000, China
    4. Department of Radiology, Liangshan Second People′s Hospital, Xichang 615000, China
  • Received:2019-01-17 Published:2019-06-20
  • Corresponding author: juan Du
  • About author:
    Corresponding author: Du juan, Email:
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引用本文：

杜娟, 范学杰, 陈红梅, 蒋飞. 甲流H1N1流感病毒性肺炎临床特征及CT影像学表现分析[J]. 中华肺部疾病杂志(电子版), 2019, 12(03): 296-300.

juan Du, Xuejie Fan, Hongmei Chen, Fei Jiang. Clinical features and CT imaging features of patients with influenza A H1N1 virus pneumonia[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2019, 12(03): 296-300.

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。

关键词: 甲型H1N1流感, 病毒性肺炎, 临床特征, CT影像学表现
Objective

To analyze the clinical features and CT imaging findings of 12 patients with influenza A virus (H1N1) 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 (H1N1) 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.

Key words: Influenza A, Viral pneumonia, Clinical features, CT imaging findings
表1 入组患者治疗前治疗后血常规检查结果[n＝12，(±s)]
项　目 白细胞 中性粒细胞 淋巴细胞 血小板
治疗前 8.49±2.45 22.31±9.22 58.33±3.27 144.44±4.32
治疗后 8.32±1.54 21.34±3.27 57.24±2.53 142.33±4.37
t值 0.794 0.343 0.913 1.189
P值 0.971 0.734 0.371 0.246
表2 入组患者治疗前治疗后生化检查结果[n＝12，(±s)]
项　目 谷丙转氨酶 谷草转氨酶 总蛋白 总胆红素 直接胆红素 间接胆红素
治疗前 25.41±2.51 56.94±3.32 56.73±7.34 9.53±3.43 6.21±2.95 8.05±2.14
治疗后 24.35±3.22 25.32±3.41 55.33±6.29 4.27±3.36 3.27±2.25 7.95±2.21
t值 0.899 23.329 0.501 3.794 2.745 0.112
P值 0.378 0.001 0.620 0.001 0.011 0.911
项　目 碱性磷酸酶 谷氨酰转肽酶 肌酸激酶 肌酸磷化酶-同工酶 乳酸脱氢酶 血尿素氮
治疗前 99.91±45.23 47.05±35.22 249.51±24.33 30.49±3.55 509.59±12.04 4.41±2.05
治疗后 60.37±45.77 46.27±34.17 252.42±24.05 29.43±3.22 103.44±12.31 4.35±1.96
t值 2.128 0.055 0.294 0.766 81.708 0.073
P值 0.044 0.956 0.771 0.451 0.001 0.942
表3 入组患者临床特征[n(%)]
临床资料 构成比
就诊时间 <3 d 0(0.00)
? 3～5 d 4(33.33)
? >5 d 8(66.66)
发热 <38.5 ℃ 1(8.33)
? >38.5 ℃ 11(91.67)
头疼 8(66.67)
肌痛 8(66.67)
气紧 11(91.67)
腹泻 5(41.67)
咳嗽 11(91.67)
咳痰 白痰 11(91.66)
? 黄痰 1(8.33)
卡他症状 3(25.00)
肺部干啰音 2(16.66)
胸闷、气紧 11(91.66)
低氧血症 10(83.33)
表4 入组患者治疗前CT影像学特点[n(%)]
CT影像学特点 构成比
病变部位 肺门病变 1(8.33)
? 周围病变 4(33.330)
? 胸膜下病变 4(33.330)
? 多发病变 3(25.00)
特点 纯磨玻璃影 5(41.66)
? 磨玻璃影＋局灶实变影 5(41.66)
? 局部低密度实变 1(8.33)
? 多发散在局灶实变影 1(8.33)
病变占全肺面积 <30% 2(16.67)
? 30～50% 4(33.33)
? >50% 6(50.00)
图1 58岁男性患者，彝族，甲流H1N1流感病毒性肺炎；注：A：为该患者治疗前CT图像，双肺见多发片状稍高密度影，边界模糊不清，密度不均匀。诊断为双肺炎症改变；B：为患者接受奥司他韦治疗5天后CT图像，双肺炎面积较治疗前明显减小
图2 51岁男性，汉族，甲流H1N1流感病毒性肺炎；注：A：为该患者治疗前CT图像，左肺见片絮状影稍高密度影，边界模糊不清，诊断为左肺上叶尖部位出现炎症改变；B：为患者治疗后CT图像，左肺上叶尖部位炎症面积较治疗前明显减少
图3 59岁女性，基础疾病：右下肺部囊状支气管扩张。院内感染：在其他医院住感染；基础疾病：骨髓瘤、间断口服激素，自然病程第3天的胸部CT，后期复查胸部CT演变为以胸膜下为主的双肺磨玻璃影
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