比较住院成人新型甲型 H1N1 流感肺炎与其他肺炎的临床特征和结局。

Comparison of clinical features and outcomes of hospitalized adult patients with novel influenza A (H1N1) pneumonia and other pneumonia.

机构信息

Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.

出版信息

Acad Emerg Med. 2013 Jan;20(1):46-53. doi: 10.1111/acem.12062.

DOI:10.1111/acem.12062

PMID:23570478

Abstract

OBJECTIVES

A novel swine-origin influenza A (H1N1) virus caused worldwide outbreaks starting in April 2009. The aim of this study was to evaluate the clinical characteristics and outcomes of pandemic 2009 H1N1 pneumonia by comparing to community-acquired pneumonia (CAP) of other origin.

METHODS

The authors conducted a prospective cohort study of consecutive adult (over 15 years old) patients with suspected CAP requiring admission to a tertiary university-affiliated hospital during the second wave of pandemic 2009 H1N1 influenza. Based on the results of real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis, the staff completed a standard assessment form and managed the patients according to a uniform protocol. Clinical characteristics, as well as laboratory and radiologic findings, were collected and compared between pandemic 2009 H1N1 pneumonia and CAP of other origin. The primary outcome was in-hospital mortality and secondary outcomes were duration of hospitalization, duration of intensive care unit (ICU) stay, and requirement of mechanical ventilation.

RESULTS

A total of 135 patients with suspected CAP were included in the study. Of these, 59 patients were RT-PCR positive for H1N1 virus, and 76 patients were RT-PCR negative. Patients with H1N1 pneumonia were significantly younger than those with CAP of other origin (46.0 years vs. 68.0 years, p < 0.01) and more frequently had nonspecific symptoms (p < 0.01), initial leukopenia (8.5% vs. 0.0%, p = 0.01), lymphopenia (45.8% vs. 26.3%, p = 0.02), low values of C-reactive protein (CRP; 5.2 mg/dL vs. 13.4 mg/dL, p = 0.02), bilateral abnormalities (57.7% vs. 29.7%, p < 0.01) on chest radiography, ground glass opacities (43.9% vs. 12.8%, p < 0.01) on chest computed tomography, and low values of pneumonia severity index (PSI) score (56.0 vs. 91.0, p < 0.01) than those with CAP of other origin. However, there were no significant differences in infection severity, clinical outcome, length of ICU stay, requirement for mechanical ventilation, and mortality between the two groups.

CONCLUSIONS

This study shows that clinical characteristics and outcomes of 2009 H1N1 pneumonia are comparable to those of CAP of other origin. However, some characteristics, including younger age, nonspecific symptoms (including headache, leukopenia, and fatigue), lymphopenia, lower initial CRP and PSI score, and radiologic findings (including bilateral abnormalities and ground glass opacities), may help clinicians to diagnostically differentiate between H1N1 pneumonia and CAP of other origin before the result of RT-PCR are obtained.

摘要

目的

一种新型的猪源甲型 H1N1 流感病毒于 2009 年 4 月引发了全球疫情。本研究旨在通过比较其他来源的社区获得性肺炎（CAP），评估大流行 2009 年 H1N1 流感引起的肺炎的临床特征和结局。

方法

作者对第二波大流行 2009 年 H1N1 流感期间需要入住三级大学附属医院的疑似 CAP 的连续成年（15 岁以上）患者进行了前瞻性队列研究。根据实时逆转录聚合酶链反应（RT-PCR）分析的结果，工作人员填写了标准评估表，并根据统一方案对患者进行了管理。收集了大流行 2009 年 H1N1 流感肺炎和其他来源 CAP 的临床特征以及实验室和影像学发现，并进行了比较。主要结局是院内死亡率，次要结局是住院时间、重症监护病房（ICU）入住时间和机械通气需求。

结果

共纳入 135 例疑似 CAP 患者。其中，59 例 RT-PCR 检测 H1N1 病毒阳性，76 例 RT-PCR 检测阴性。H1N1 肺炎患者明显比其他来源 CAP 的患者年轻（46.0 岁 vs. 68.0 岁，p < 0.01），且更常出现非特异性症状（p < 0.01）、初始白细胞减少症（8.5% vs. 0.0%，p = 0.01）、淋巴细胞减少症（45.8% vs. 26.3%，p = 0.02）、C 反应蛋白（CRP）值较低（5.2 mg/dL vs. 13.4 mg/dL，p = 0.02）、胸部 X 线双侧异常（57.7% vs. 29.7%，p < 0.01）、胸部 CT 有磨玻璃影（43.9% vs. 12.8%，p < 0.01）、肺炎严重指数（PSI）评分较低（56.0 vs. 91.0，p < 0.01）。然而，两组之间的感染严重程度、临床结局、ICU 入住时间、机械通气需求和死亡率无显著差异。

结论

本研究表明，2009 年 H1N1 流感肺炎的临床特征和结局与其他来源 CAP 的相似。然而，一些特征，包括年龄较小、非特异性症状（包括头痛、白细胞减少和疲劳）、淋巴细胞减少症、较低的初始 CRP 和 PSI 评分以及影像学表现（包括双侧异常和磨玻璃影），可能有助于临床医生在获得 RT-PCR 结果之前，对 H1N1 肺炎和其他来源 CAP 进行诊断区分。