Sha Li, Cao Ling, Chen Hui-zhong, Yuan Yi, Zhu Ru-nan, Deng Jie, Wang Fang, Sun Yu, Qian Yuan, Du Jun-bao
Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
Zhonghua Er Ke Za Zhi. 2010 Aug;48(8):575-9.
To analyze the clinical characteristics of hospitalized pediatric patients infected with 2009 H1N1 influenza.
Totally 159 children (83 male and 76 female) with influenza A (H1N1) confirmed by the real-time reverse-transcriptase-polymerase-chain-reaction assay were admitted to a special ward of Capital Institute of Pediatrics from November 2009 to January 2010. Clinical manifestations, laboratory and therapy data from the hospitalized children were collected by designed case report form and analyzed.
Out of 159 hospitalized patients, 139 (87.4%) were under the age of 5 years and 34.0% of them had at least one underlying medical conditions. Proportions of the severe cases, pneumonia and underlying medical diseases were similar between the 78 infants and 81 older children. All of these 159 cases had influenza-like symptoms at onset and the most common presentations were fever (115 cases, 72.3%) and cough (154 cases, 96.8%). Five severe cases presented dyspnea, cyanosis and hypoxemia. The virus easily invaded into the lower respiratory tract as indicated by that 61% of the cases had findings consistent with pneumonia by X-ray and/or CT and 21.6% had bacterial co-infection. Part of them had mycoplasma pneumonia (20 cases, 27.0%) or other respiratory viruses (5 cases, 3.1%) co-infection simultaneously. The duration of fever was similar between the H1N1 virus sole infection group and the co-infection group (t = 0.975, P > 0.05), but the average course of the disease and hospitalized days of the latter group were longer than the former (t = 3.182 and 3.190, P < 0.01). The proportion of children with pneumonia in the co-infection group was significantly higher than that in the H1N1 sole-infection group (χ(2) = 4.082, P < 0.05).
Most of the H1N1 infected pediatric patients had mild respiratory symptoms, a few of them developed severe manifestations. Dyspnea and hypoxemia were the early signals for the developing severe cases. Rational and experienced treatment with antibiotics was important addition to the antiviral therapy for those co-infected with bacteria.
分析2009年甲型H1N1流感住院儿童患者的临床特征。
2009年11月至2010年1月，159例经实时逆转录聚合酶链反应检测确诊为甲型H1N1流感的儿童（男83例，女76例）入住首都儿科研究所的一个特殊病房。通过设计好的病例报告表收集住院儿童的临床表现、实验室及治疗数据并进行分析。
159例住院患者中，139例（87.4%）年龄在5岁以下，其中34.0%至少有一种基础疾病。78例婴儿和81例大龄儿童中重症病例、肺炎及基础疾病的比例相似。这159例患者起病时均有流感样症状，最常见的表现为发热（115例，72.3%）和咳嗽（154例，96.8%）。5例重症病例出现呼吸困难、发绀和低氧血症。病毒易侵袭下呼吸道，61%的病例X线和/或CT检查结果符合肺炎表现，21.6%有细菌合并感染。部分患者同时合并支原体肺炎（20例，27.0%）或其他呼吸道病毒感染（5例，3.1%）。甲型H1N1病毒单纯感染组与合并感染组发热持续时间相似（t = 0.975，P > 0.05），但合并感染组的平均病程和住院天数长于单纯感染组（t = 3.182和3.190，P < 0.01）。合并感染组肺炎患儿比例显著高于甲型H1N1病毒单纯感染组（χ(2) = 4.082，P < 0.05）。
大多数甲型H1N1流感感染儿童患者有轻度呼吸道症状，少数发展为重症表现。呼吸困难和低氧血症是重症病例发展的早期信号。对于合并细菌感染的患者，合理且经验性地使用抗生素是抗病毒治疗的重要补充。
