Wang Yu, Chen Feng-xin, Zhang Ming, Wu Liang, Sun Xiao-liang
The Centre of Critical Illness, Beijing Ditan Hospital, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2009 Oct;43(10):856-60.
To study the clinical characteristics and laboratory results of 24 confirmed H1N1 influenza cases.
The characters of clinical, laboratory, iconography and etiology of 24 patients with A/H1N1 were studied, and the changes of T-lymphocyte subsets that between the pre- and post-treatment were evaluated.
The ages of patients were ranged from 6 to 65 years old; average age was 26 years old.15 patients were under 25 years old. 22 (22/24, 91.7%) patients had recently traveled to USA or Canada. The most common presenting symptoms were: fever (22/24, 91.7%); sore throat (22/24, 91.7%); cough (20/24, 83.3%); dry cough (14/24, 58.3%); expectoration (6/24, 25.0%); nasal discharge (6/24, 25.0%). Six had pneumonia in sixteen patients (6/16, 37.5%) who took CT scan; seven (7/24, 29.2%) had headache and four (4/24, 16.7%) had muscular soreness; two (2/24, 8.3%) had sneeze and nasal obstruction; only one(1/24, 4.2%) had diarrhea; one (1/24, 4.2%) had conjunctivitis. The result of 23 patients about T-Lymphocyte subsets: most of CD4 and CD8 were decreased (18/23, 78.3%), ranging from 122 to 691 cells/microl (normal was 706 - 1125 cells/microl), with the average of 408 cells/microl, but ratios of CD4/CD8 were normal. Fourteen patients were detected CD4 and CD8 after received the treatment during 5 to 7 days.the results of CD4 (cells/microl) were different between the pre- and post-treatment: 436.29 +/- 189.06, 976.71 +/- 332.96 (paired-samples t test: t = -5.416, P < 0.05) while the results of CD8 (cells/microl) were: 323.64 +/- 176.47, 703.14 +/- 211.77 (t = -5.319, P < 0.05); the results of leukocytes in 22 patients were different between pre- and post-treatment: (5.13 +/- 1.47) x 10(9)/L, (6.25 +/- 1.37) x 10(9)/L (t = -2.900, P < 0.05) while the results of lymphocytes were: (1.16 +/- 0.43) x 10(9)/L, (2.30 +/- 0.37) x 10(9)/L (t = -6.819, P < 0.05); but the ratios of CD4/CD8 were: 1.44 +/- 0.41, 1.40 +/- 0.26 (t = 0.507, P > 0.05). All the patients were received antivirus treatment (Oseltamivir) and the virus conversed during 1 - 10 days (average 4.5 days). The temperature was normal after onset during 3 - 4 days and the patients were recovered during 3 - 13 days (with the average of 7.3 days).
Influenza A virus H1N1 subtype was identified as the cause of outbreaks of febrile respiratory infection which was self-limited. There was no evidence to show that the changes of T-Lymphocyte subsets could indicate the prognosis of patients.
研究24例确诊的H1N1流感病例的临床特征和实验室检查结果。
对24例甲型H1N1流感患者的临床、实验室、影像学及病因学特征进行研究,并评估治疗前后T淋巴细胞亚群的变化。
患者年龄范围为6至65岁,平均年龄26岁。15例患者年龄在25岁以下。22例(22/24,91.7%)患者近期去过美国或加拿大。最常见的症状为:发热(22/24,91.7%);咽痛(22/24,91.7%);咳嗽(20/24,83.3%);干咳(14/24,58.3%);咳痰(6/24,25.0%);流涕(6/24,25.0%)。16例行CT检查的患者中有6例(6/16,37.5%)发生肺炎;7例(7/24,29.2%)有头痛,4例(4/24,16.7%)有肌肉酸痛;2例(2/24,8.3%)有打喷嚏和鼻塞;仅1例(1/24,4.2%)有腹泻;1例(1/24,4.2%)有结膜炎。23例患者T淋巴细胞亚群检测结果:多数CD4和CD8降低(18/23,78.3%),范围为122至691个细胞/微升(正常为706 - 1125个细胞/微升),平均为408个细胞/微升,但CD4/CD8比值正常。14例患者在治疗5至7天后检测CD4和CD8。治疗前后CD4(细胞/微升)结果不同:436.29±189.06,976.71±332.96(配对样本t检验:t = -5.416,P < 0.05),而CD8(细胞/微升)结果为:323.64±176.47,703.14±211.77(t = -5.319,P < 0.05);22例患者治疗前后白细胞结果不同:(5.13±1.47)×10⁹/L,(6.25±1.37)×10⁹/L(t = -2.900,P < 0.05),淋巴细胞结果为:(1.16±0.43)×10⁹/L,(2.30±0.37)×10⁹/L(t = -6.819,P < 0.05);但CD4/CD8比值为:1.44±0.41,1.40±0.26(t = 0.507,P > 0.05)。所有患者均接受抗病毒治疗(奥司他韦),病毒在1至10天内转阴(平均4.5天)。发病后3至4天体温恢复正常,患者在3至13天内康复(平均7.3天)。
甲型H1N1流感病毒被确定为发热性呼吸道感染暴发的病因,该感染具有自限性。没有证据表明T淋巴细胞亚群的变化可提示患者的预后。