Gürgün Alev, Bacakoğlu Feza, Başoğlu Ozen Kaçmaz, Taşbakan Mehmet Sezai, Pullukçu Hüsnü, Sayıner Abdullah
Department of Chest Diseases, Faculty of Medicine, Ege University, İzmir, Turkey.
Tuberk Toraks. 2010;58(4):357-65.
Prognosis of pandemic influenza A (H1N1) virus pneumonia is worse than community-acquired pneumonia (CAP), therefore it is important to know distinctive clinical features of both pneumonias. The aims of this study were to compare clinical features and prognosis of patients with pandemic influenza A (H1N1) pneumonia and CAP due to other agents. Demographic features, symptoms and findings of 20 pandemic influenza A (H1N1) pneumonia and 18 CAP patients hospitalized between October 1st and December 30th, 2009 were evaluated. One patient (5.0%) with pandemic Influenza A (H1N1) pneumonia and 55.6% of CAP patients were over 65 years (p= 0.001). Symptoms of fever, dyspnea, fatigue, muscle and joint pain, nausea, vomiting and headache were more frequent (p< 0.05), platelet count (p= 0.024) and PaO(2)/FiO(2) ratio (p= 0.006) were lower, number of thrombocytopenic patients (p= 0.024) and LDH levels (p= 0.016) were higher, duration of hospitalization was longer (p= 0.038) in patients with pandemic influenza A (H1N1) pneumonia. There was no difference in terms of radiological findings between two groups. None of the CAP patients were followed-up in the intensive care, whereas five pandemic influenza A (H1N1) pneumonia patients (25.0%) required intensive care and three of them died despite invasive mechanical ventilation. In conclusion, in the presence of fever, dyspnea with non-pulmonary symptoms and accompanying radiological alveolar opacities should be considered as pandemic influenza A (H1N1) pneumonia should be suspected in patients admitted with findings of pneumonia during influenza season. Admission to the intensive care unit and mechanical ventilation should be considered in patients with dyspnea and diffuse radiological findings.
甲型H1N1流感大流行病毒肺炎的预后比社区获得性肺炎(CAP)更差,因此了解这两种肺炎的独特临床特征很重要。本研究的目的是比较甲型H1N1流感大流行肺炎患者与其他病原体所致CAP患者的临床特征和预后。对2009年10月1日至12月30日期间住院的20例甲型H1N1流感大流行肺炎患者和18例CAP患者的人口统计学特征、症状及检查结果进行了评估。1例(5.0%)甲型H1N1流感大流行肺炎患者和55.6%的CAP患者年龄超过65岁(p = 0.001)。甲型H1N1流感大流行肺炎患者发热、呼吸困难、乏力、肌肉和关节疼痛、恶心、呕吐及头痛等症状更常见(p < 0.05),血小板计数(p = 0.024)和PaO(2)/FiO(2)比值(p = 0.006)更低,血小板减少患者数量(p = 0.024)和乳酸脱氢酶水平(p = 0.016)更高,住院时间更长(p = 0.038)。两组间影像学检查结果无差异。CAP患者均未在重症监护室接受随访,而5例甲型H1N1流感大流行肺炎患者(25.0%)需要重症监护,其中3例尽管接受了有创机械通气仍死亡。总之,在流感季节,对于出现肺炎症状的患者,若伴有发热、呼吸困难及非肺部症状且影像学表现为肺泡性实变,应怀疑为甲型H1N1流感大流行肺炎。对于出现呼吸困难及弥漫性影像学表现的患者,应考虑收入重症监护病房并进行机械通气。