CAJ | 학술논문

目的分析2例重症新型甲型H1N1流感(简称甲型流感)合并肺炎患者的临床表现、影像学特点和治疗经过,提高对本病的认识.方法回顾性分析2009年9月入住南京市第二医院南山分院的2例确诊为甲型流感合并肺炎患者的临床表现、胸部CT特点及治疗经过.结果 2例患者中1例为女性,54岁,无基础疾病;1例为男性,31岁,有支气管哮喘史.主要症状和体征为发热、咳嗽,肺部可闻及湿性哕音.2例患者胸部CT主要表现为实变影及磨玻璃影,以双下肺和胸膜下分布为主,累及多个肺叶、肺段,实变影内可见支气管充气征.2例患者咽拭子甲型H1N1流感病毒核酸阳性,确诊为甲型流感.2例患者入院时均存在低氧血症,白细胞计数和淋巴细胞计数下降,血乳酸脱氢酶(LDH)水平和肌酸激酶(CK)水平明显升高.2例患者均接受奥司他韦、糖皮质激素以及吸氧等对症支持治疗,其中1例间断接受无创通气.治疗后,临床症状缓解,胸部CT示实变影和磨玻璃影较入院时明显吸收.白细胞计数、LDH及CK水平恢复正常,复查咽拭子甲型H1N1流感病毒核酸阴性,康复出院.结论部分甲型流感患者可合并肺炎,临床表现无特异性,胸部CT主要表现为双肺弥漫性分布的实变影及磨玻璃影;及时动态复查胸部CT对诊断和了解病情进展非常必要;糖皮质激素可缓解甲型流感合并肺炎患者咳嗽及气喘等症状,有助于肺部病变的吸收.
목적 분석2례중증신형갑형H1N1류감(간칭갑형류감)합병폐염환자적림상표현、영상학특점화치료경과,제고대본병적인식.방법 회고성분석2009년9월입주남경시제이의원남산분원적2례학진위갑형류감합병폐염환자적림상표현、흉부CT특점급치료경과.결과 2례환자중1례위녀성,54세,무기출질병;1례위남성,31세,유지기관효천사.주요증상화체정위발열、해수,폐부가문급습성홰음.2례환자흉부CT주요표현위실변영급마파리영,이쌍하폐화흉막하분포위주,루급다개폐협、폐단,실변영내가견지기관충기정.2례환자인식자갑형H1N1류감병독핵산양성,학진위갑형류감.2례환자입원시균존재저양혈증,백세포계수화림파세포계수하강,혈유산탈경매(LDH)수평화기산격매(CK)수평명현승고.2례환자균접수오사타위、당피질격소이급흡양등대증지지치료,기중1례간단접수무창통기.치료후,림상증상완해,흉부CT시실변영화마파리영교입원시명현흡수.백세포계수、LDH급CK수평회복정상,복사인식자갑형H1N1류감병독핵산음성,강복출원.결론 부분갑형류감환자가합병폐염,림상표현무특이성,흉부CT주요표현위쌍폐미만성분포적실변영급마파리영;급시동태복사흉부CT대진단화료해병정진전비상필요;당피질격소가완해갑형류감합병폐염환자해수급기천등증상,유조우폐부병변적흡수.
Objective To improve understanding of the novel influenza A (H1N1) virus infection complicated with pneumonia. Method Clinical presentations, radiological data, laboratory data and treatments of 2 patients with pneumonia caused by the novel influenza A (H1N1) virus were retrospectively analyzed. Results One patient was a middle-aged woman, and the other was a young man with a history of asthma. Both patients had fever (temperatures more than 39℃), cough, and dyspnea. At the time of admission, both patients had hypoxemia. Chest computed tomography (CT) scan showed patchy distribution of consolidation and ground-glass opacity mainly in peripheral subpleural regions, as well as peribrochovascular lesions with air-bronchogram. The decreased and lymphocytes, elevated lactate dehydrogenase and creatine kinase were found in both patients. After admission, the patients received oseltamivir with a dose of 75 mg twice a day for a minimum of 5 days. Other treatments included antibiotics and methylprednisolone. One patient needed intermittent non-invasive ventilation for respiratory distress. Both patients recovered and the opacities on their chest CT were almost absorbed. WBC counts increased to normal and the levels of LDH and CK decreased. Conclusions Patients with the novel influenza A (H1N1) virus infection may develop pneumonia. The manifestations are non-specific. Chest CT scan reveals patchy distribution of consolidation and ground-glass opacity. In addition to antiviral therapy, glucocorticoids may have some effects on the pulmonary lesions and be useful for improving the clinical conditions.