CAJ | 학술논문

目的探讨妊娠期重症甲型H1N1流感肺炎患者的临床特点,提高对妊娠期重症甲型H1N1流感肺炎的认识.方法分析我院2009年11月26日至12月20日收治的15例妊娠期重症甲型H1N1流感肺炎患者临床资料.结果 15例患者平均年龄24岁,平均孕周32周,白细胞总数平均值(6.76±3.30)×109/L[(1.30～14.60)×109/L],2例低于4×109/L,最低1.3×109/L;3例高于10×109/L,最高14.6×109/L.中性粒细胞比率(87.62±4.00)%[(79.40～92.90)%],均高于正常.淋巴细胞绝对值(0.70±0.24)×109/L[(0.20～1.20)×109/L],13例(86.7%)低于1×109/L.单核细胞计数平均值(0.10±0.13)×109/L[(0～0.4)×109/L],13例(86.7%)低于0.2 × 109/L,6例计数为0.12例患者检查T淋巴细胞亚群CD4/CD8中有6例(54.5%)<1.4,其中5例<1.CDl9相对值21.09±10.39(12～47),其中6例(40%)>18.CD16+56相对值为8.45±3.83(3～15),4例(26.7%)<8,其余所有测定值接近低限.14例患者血乳酸脱氢酶平均(400.84±262.84)U/L[(0.80～850.00)U/L],其中10例(71.4%)增高.肌酸激酶(512.47±1250.67)U/L[(25～5088)U/L],4例患者(26.6%)高于正常值,同时伴有同工酶升高.15例中4例(26.7%)血钾<3.5 mmol/L.12例患者免疫相关检查中有4例(33.3%)补体CA>0.36g/L,1例(6.7%)<0.09 g/L;4例(33.3%)C3<0.75 g/L;免疫球蛋白及免疫复合物大致正常.15例患者放射影像均确定存在多发、多叶肺炎,主要呈间质样改变或大片实变渗出.需要机械通气辅助呼吸的病例影像学特点为双肺弥漫大面积实变影,连续监测进展迅速,符合ARDS影像学表现.4例出现少量胸腔积液,1例合并少量心包积液.患者中有2例晚期妊娠孕妇胚胎死亡,7例及时终止妊娠者病情稳定.结论妊娠期妇女是甲型H1N1病毒感染的高危人群,并易迅速发展成为ARDS.妊娠期免疫耐受可能参与重症H1N1流感肺炎肺部损伤过程.
목적 탐토임신기중증갑형H1N1류감폐염환자적림상특점,제고대임신기중증갑형H1N1류감폐염적인식.방법 분석아원2009년11월26일지12월20일수치적15례임신기중증갑형H1N1류감폐염환자림상자료.결과 15례환자평균년령24세,평균잉주32주,백세포총수평균치(6.76±3.30)×109/L[(1.30～14.60)×109/L],2례저우4×109/L,최저1.3×109/L;3례고우10×109/L,최고14.6×109/L.중성립세포비솔(87.62±4.00)%[(79.40～92.90)%],균고우정상.림파세포절대치(0.70±0.24)×109/L[(0.20～1.20)×109/L],13례(86.7%)저우1×109/L.단핵세포계수평균치(0.10±0.13)×109/L[(0～0.4)×109/L],13례(86.7%)저우0.2 × 109/L,6례계수위0.12례환자검사T림파세포아군CD4/CD8중유6례(54.5%)<1.4,기중5례<1.CDl9상대치21.09±10.39(12～47),기중6례(40%)>18.CD16+56상대치위8.45±3.83(3～15),4례(26.7%)<8,기여소유측정치접근저한.14례환자혈유산탈경매평균(400.84±262.84)U/L[(0.80～850.00)U/L],기중10례(71.4%)증고.기산격매(512.47±1250.67)U/L[(25～5088)U/L],4례환자(26.6%)고우정상치,동시반유동공매승고.15례중4례(26.7%)혈갑<3.5 mmol/L.12례환자면역상관검사중유4례(33.3%)보체CA>0.36g/L,1례(6.7%)<0.09 g/L;4례(33.3%)C3<0.75 g/L;면역구단백급면역복합물대치정상.15례환자방사영상균학정존재다발、다협폐염,주요정간질양개변혹대편실변삼출.수요궤계통기보조호흡적병례영상학특점위쌍폐미만대면적실변영,련속감측진전신속,부합ARDS영상학표현.4례출현소량흉강적액,1례합병소량심포적액.환자중유2례만기임신잉부배태사망,7례급시종지임신자병정은정.결론 임신기부녀시갑형H1N1병독감염적고위인군,병역신속발전성위ARDS.임신기면역내수가능삼여중증H1N1류감폐염폐부손상과정.
Objective To investigate the clinical characteristics of severe patients with influenza A H1N1. Methods Fifteen prenant pneumonia patients with influenza A H1N1 were selected from November 26 to December 20,2009. Results The average age of all patients was 24 years old,with an average gestational age of 32 weeks. Leukopenia was observed in 13. 3% of IS patients,and lymphopenia in 86. 7%. Data on the ratio of CD4 cells to CD8 cells were available for 12 patients,54. 5% of whom had an abnormal CD4:CD8 ratio(< 1. 4). Ten of the 14 patients(71. 4%)had increased serum lactate dehydrogenase levels,which were above 245 U per liter. Four patients (26. 6%) had elevated creatine kinase levels at admission. 4 cases of 15 patients (26. 7%) had decreased serum potassium levels,which were below 3.5 mmol per liter. Four patients (33. 3%)had C4 levels higer than 36 g per liter,and 4 cases had C3 less than 0.75 g per liter. All 15 patients had radiologically confirmed pneumonia with bilateral patchy alveolar opacities, affecting three or four lung quadrants. Findings on chest radiographs were consistent with the acute respiratory distress syndrome in all patients requiring mechanical ventilation. 4 cases were found a small amount of pleural effusion, of which 1 case was combined a small amount of pericardial effusion. Respiratory distress requiring intubation and mechanical ventilation developed in 9 patients within the first 24 hours after admission, who were all pregnant women. Two of them in the third trimester died, and 7 cases who were timely terminated pregnancy were in stable condition. Conclusions Pandemic influenza A(HIM) may pose an increased risk of severe illness in pregnant women, and it is easy to develop rapidly into adult respiratory distress syndrome. The pregnancy immunological tolerance may be involved in the severe lung injury process of H1N1 influenza pneumonia.