| 许少华， 李宏军， 李宁， 胡春红， 李润涛， 齐石， 李云芳， 丁金立， 张岩岩， 米海峰， 张琦， 柳娇娇.人感染H7N9禽流感与甲型H1N1流感重症肺炎的临床及CT影像比较[J].放射学实践,2014,(07):756-759 |
| 人感染H7N9禽流感与甲型H1N1流感重症肺炎的临床及CT影像比较 |
| Comparative study of CT findings and clinical course of patients with severe pneumonia due to avian influenza H7N9 and swine influenza H1N1 infection |
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| DOI：10.13609/j.cnki.1000 0313.2014.07.006 |
| 中文关键词: 禽流感 甲型流感 肺炎 体层摄影术，X线计算机 |
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| 【摘要】目的：比较人感染H7N9禽流感与甲型H1N1流感重症肺炎的临床及CT影像学特点。方法：回顾性分析12例人感染H7N9禽流感（H7N9组）和21例甲型H1N1流感重症肺炎患者（H1N1组）的临床表现、并发症及治疗转归和CT影像学资料。结果：H7N9组基础疾病和进入ICU接受治疗的比例均高于H1N1组（χ2=3.111，P<0.05；χ2=3.599，P<0.05））。H7N9组发病初期伴有呼吸困难和气促、呼吸窘迫综合症的发生率均高于H1N1组（双侧P<0.001；χ2=3.111，P<0.05）。H7N9组患者有创机械通气治疗和死亡率均高于H1N1病毒感染组（χ2=7.219，P<0.01；双侧P<0.05）。两组流感患者主要病理表现为肺间质和实质损伤，其基本CT影像改变是肺内磨玻璃密度影和肺实变密度影。H7N9组患者胸腔积液和网格状密度增高表现多于H1N1组（双侧P<0.05）。结论：与H1N1组患者相比，H7N9组患者基础疾病多、病情进展更为迅猛、并发症更为严重、死亡率更高。CT检查能客观反映二者的影像特征，有助于指导临床治疗和疗效评估，但仅凭CT影像资料不能对二者进行鉴别诊断。 |
| 【Abstract】Objective:To compare the CT characteristics and clinical course in patients with severe pneumonia due to avian influenza H7N9 and swine influenza H1N1 infection.Methods:The materials of epidemiology,serology,clinical manifestations,complications,treatment outcome and CT findings of severe pneumonia in 21 patients with influenza A (H1N1) and 12 patients with influenza H7N9 were retrospectively analyzed.Results:The age of H7N9 patients were older and they had more basic diseases (χ2=3.111,P<0.05).In addition,the proportion of ICU treatment in H7N9 patients was higher than that in H1N1 patients (χ2=3.599,P<0.05).The onset symptoms of the 2 groups were fever and cough,and might be accompanied by running nose,expectoration,fatigue,nausea,vomiting,diarrhea and abdominal pain.Moist rales and wheezing sound could be assessed on auscultation.Bloody or rusty sputum in H7N9 infections was more observed than that in H1N1 (P<0.05).Dyspnea and shortness of breath in H7N9 infections were more (P<0.001),as well as the incidence of complicated acute ARDS was higher (χ2=3.111,P<0.05).Treatment with invasive mechanical ventilation as well as mortality were higher in H7N9 group compared with that of H1N1 group (χ2=7.219,P<0.01;P<0.05).In both two groups,the major pathology was invasion of pulmonary parenchyma and interstitial tissue.The fundamental pulmonary CT findings were pulmonary ground glass opacities (GGOs) and consolidations,often associated with air bronchogram;interlobular septum thickening,bronchiectasis,lymph node enlargement or pleural effusion could also be revealed.Pleural effusion and reticular appearance of lung in H7N9 group were more observed than that in H1N1 group (P<0.05).Conclusion：Compared with influenza A (H1N1) patients,H7N9 patients were older in age,with more basic diseases,serious complications and more rapid progression of disease,mortality was higher as well.CT not only could display objectively the imaging characteristics of the two disease entities,but also is helpful in treatment guidance and prognosis prediction.However,only depends on CT findings,differential diagnosis of the two diseases could not be made. |
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