中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2010年
10期
746-749
,共4页
陆普选%邓莹莹%杨桂林%刘映霞%干芸根%李国保%刘威龙%刘艳%张晶%叶如馨%单万水%周伯平
陸普選%鄧瑩瑩%楊桂林%劉映霞%榦蕓根%李國保%劉威龍%劉豔%張晶%葉如馨%單萬水%週伯平
륙보선%산형형%양계림%류영하%간예근%리국보%류위룡%류염%장정%협여형%단만수%주백평
流感病毒A型,H1N1亚型%肺炎%病毒载量%体层摄影术,X线计算机
流感病毒A型,H1N1亞型%肺炎%病毒載量%體層攝影術,X線計算機
류감병독A형,H1N1아형%폐염%병독재량%체층섭영술,X선계산궤
Influenza A,H1N1%Pneumonia%Viral load%Tomography X-ray computed
目的 观察新型甲型H1N1流感(简称甲型流感)患者体内病毒载量与胸部CT表现的动态变化,探讨病毒载量与胸部CT表现对甲型流感的诊断、鉴别诊断及指导治疗的价值.方法 收集2009年5-12月深圳市第三人民医院收治的51例甲型H1N1流感核酸检测阳性的患者,均符合卫生部颁布的"甲型H1N1流感诊断标准",均行胸部X线及CT扫描(含高分辨率CT)并测定体内病毒载量.根据CT影像检查有否肺炎征象将甲型流感患者分为肺炎组31例和非肺炎组20例,观察胸部CT所见与病毒载量变化的关系.结果 (1)甲型流感肺炎组患者胸部CT主要表现为片状实变影,早期和吸收期表现为磨玻璃影,双肺散在小叶性或节段性阴影,以下肺叶多见,左下肺叶明显,可伴有纵隔淋巴结肿大,肺实质、肺间质及胸膜可同时受累;(2)发病甲期患者体内病毒载量高,肺炎组病毒载量的均值为7.7拷贝/ml,非肺炎组为4.2拷贝/ml;抗病毒治疗4 d(病程第6天)病毒核酸开始转阴;(3)3例肺炎患者中2例病毒核酸转阴时间快于胸部CT病灶吸收时间,而1例年幼患者的病毒核酸转阴时间明显延长.结论 甲型流感合并肺炎患者的病毒载量明显高于未合并肺炎的患者;动态观察甲型流感合并感肺炎患者的影像学表现及病毒载量的变化,有利于对甲型流感患者进行及时有效的治疗.
目的 觀察新型甲型H1N1流感(簡稱甲型流感)患者體內病毒載量與胸部CT錶現的動態變化,探討病毒載量與胸部CT錶現對甲型流感的診斷、鑒彆診斷及指導治療的價值.方法 收集2009年5-12月深圳市第三人民醫院收治的51例甲型H1N1流感覈痠檢測暘性的患者,均符閤衛生部頒佈的"甲型H1N1流感診斷標準",均行胸部X線及CT掃描(含高分辨率CT)併測定體內病毒載量.根據CT影像檢查有否肺炎徵象將甲型流感患者分為肺炎組31例和非肺炎組20例,觀察胸部CT所見與病毒載量變化的關繫.結果 (1)甲型流感肺炎組患者胸部CT主要錶現為片狀實變影,早期和吸收期錶現為磨玻璃影,雙肺散在小葉性或節段性陰影,以下肺葉多見,左下肺葉明顯,可伴有縱隔淋巴結腫大,肺實質、肺間質及胸膜可同時受纍;(2)髮病甲期患者體內病毒載量高,肺炎組病毒載量的均值為7.7拷貝/ml,非肺炎組為4.2拷貝/ml;抗病毒治療4 d(病程第6天)病毒覈痠開始轉陰;(3)3例肺炎患者中2例病毒覈痠轉陰時間快于胸部CT病竈吸收時間,而1例年幼患者的病毒覈痠轉陰時間明顯延長.結論 甲型流感閤併肺炎患者的病毒載量明顯高于未閤併肺炎的患者;動態觀察甲型流感閤併感肺炎患者的影像學錶現及病毒載量的變化,有利于對甲型流感患者進行及時有效的治療.
목적 관찰신형갑형H1N1류감(간칭갑형류감)환자체내병독재량여흉부CT표현적동태변화,탐토병독재량여흉부CT표현대갑형류감적진단、감별진단급지도치료적개치.방법 수집2009년5-12월심수시제삼인민의원수치적51례갑형H1N1류감핵산검측양성적환자,균부합위생부반포적"갑형H1N1류감진단표준",균행흉부X선급CT소묘(함고분변솔CT)병측정체내병독재량.근거CT영상검사유부폐염정상장갑형류감환자분위폐염조31례화비폐염조20례,관찰흉부CT소견여병독재량변화적관계.결과 (1)갑형류감폐염조환자흉부CT주요표현위편상실변영,조기화흡수기표현위마파리영,쌍폐산재소협성혹절단성음영,이하폐협다견,좌하폐협명현,가반유종격림파결종대,폐실질、폐간질급흉막가동시수루;(2)발병갑기환자체내병독재량고,폐염조병독재량적균치위7.7고패/ml,비폐염조위4.2고패/ml;항병독치료4 d(병정제6천)병독핵산개시전음;(3)3례폐염환자중2례병독핵산전음시간쾌우흉부CT병조흡수시간,이1례년유환자적병독핵산전음시간명현연장.결론 갑형류감합병폐염환자적병독재량명현고우미합병폐염적환자;동태관찰갑형류감합병감폐염환자적영상학표현급병독재량적변화,유리우대갑형류감환자진행급시유효적치료.
Objective To evaluate the value of chest CT findings and dynamic changes of viral load in patients with novel influenza A (H1N1) infection in clinical diagnosis, differential diagnosis and treatment Methods Fifty-one patients with confirmed novel influenza A (H1N1) according to the diagnostic criteria of the Ministry of Health, received chest X-ray, CT scans (HRCT) and viral load tests in our hospital from May to December of 2009. Based on whether there were signs of pneumonia in CT imaging,the patients were divided into a pneumonia group (n = 31 ) and a non-pneumonia group (n = 20). The relationship between chest CT changes and viral load was observed and analyzed statistically using SPSS 10. 5 software. Results Patchy consolidations of lungs were the main findings in pneumonia group with influenza A( H1N1 )infection, and ground-glass opacities were the main CT findings at acute and convalescent phases.Lobular and segmental shadows of the lungs were diffusely distributed, mostly found in lower lungs,especially the left lung. In some cases, the lung diseases were accompanied with mediastinal lymphadenopathy. Co-existence of pulmonary parenchymal, interstitial and pleural diseases was observed.Peak viral load occurred at the early phase of illness, with the mean initial viral load being 7.7 copies/ml and 4. 2 copies/ml in the pneumonia and the non-pneumonia groups respectively. The viral nucleic acid became negative 4 days after antiviral treatment (course of 6 days). Dynamic observation of 3 patients with novel influenza A (H1N1 ) pneumonia showed that, the viral clearance period preceded the absorption of lung lesions in 2 cases, but viral clearance period of a young patient was significantly prolonged. ConclusionIn patients with the novel influenza A (H1N1) infection, the viral load in the pneumonia group was significantly higher than that in the group with normal chest imaging. Dynamic observation on chest imaging and viral load may be beneficial for clinicians to start prompt and effective treatment.
