Zhonghua Er Ke Za Zhi. 2010 Oct;48(10):733-8.
The pandemic influenza in 2009 was caused by a new virus, influenza A (H1N1) virus which has never been found in human before. The papers published at different time, in different places by authors from different institutions show different clinical features. Herein, we describe the clinical features of hospitalized children with 2009 influenza A (H1N1) infection from multi-centers all over the country retrospectively.
Clinical data of 810 cases with 2009 influenza A (H1N1) infection were collected from 17 hospitals. The clinical characteristics, laboratory abnormalities, treatment and outcomes were retrospectively studied.
Of the 810 hospitalized children with 2009 influenza A (H1N1) infection, 508 (62.7%) were male, 302 (37.3%) female; the median age was 43 months, 550 (67.9%) were under 5 years of age; 148 (18.5%) had underlying chronic disease. The common presenting symptoms were fever (96.3%), runny nose (36.3%), stuffiness (23.7%), sore throat (18.1%), cough (93.7%), sputum (42.8%), wheezing (27.0%), dyspnea (20.1%), vomiting (16.0%), diarrhea (8.1%), irritability (9.8%), lethargy (7.9%) and seizures (4.0%). The common laboratory abnormalities were abnormal results of white blood cells counts (46.5%), elevations of lactate dehydrogenase (LDH, 42.7%), elevated C-reactive protein (CRP, 37.8%), aspartate transaminase (AST, 31.7%) and creatine kinase (CK, 21.5%). Clinical complications included pneumonia 586 (72.3%), encephalopathy/encephalitis 49 (6.0%), and myocarditis 30 (3.7%); 183 children had critical illness. The incidence of having underlying chronic disease, leukocytosis, neutrophilia, lymphopenia and elevations of CRP were high in critically ill patients. Totally 19 (2.3%) died, 8 died from encephalopathy/encephalitis; 10 died from severe pneumonia and ARDS, of whom 5 patients were complicated with encephalopathy/encephalitis; 1 died from secondary fungal meningitis.
Hospitalized children with 2009 influenza A (H1N1) infection may have a wide involvement of organ systems. The risk factors for critical illness were having underlying chronic disease, leukocytosis, neutrophilia, lymphopenia and elevations of CRP. Complications of severe pneumonia, ARDS, and encephalopathy/encephalitis were main causes of death.
2009年大流行性流感由一种新型病毒甲型H1N1流感病毒引起，该病毒此前从未在人类中发现。来自不同机构的作者在不同时间、不同地点发表的论文显示出不同的临床特征。在此，我们回顾性描述全国多中心2009年甲型H1N1流感感染住院儿童的临床特征。
收集来自17家医院的810例2009年甲型H1N1流感感染病例的临床资料。对临床特征、实验室异常、治疗及转归进行回顾性研究。
810例2009年甲型H1N1流感感染住院儿童中，男性508例（62.7%），女性302例（37.3%）；中位年龄43个月，5岁以下550例（67.9%）；148例（18.5%）有基础慢性病。常见的临床表现为发热（96.3%）、流涕（36.3%）、鼻塞（23.7%）、咽痛（18.1%）、咳嗽（93.7%）、咳痰（42.8%）、喘息（27.0%）、呼吸困难（20.1%）、呕吐（16.0%）、腹泻（8.1%）、烦躁（9.8%）、嗜睡（7.9%）及惊厥（4.0%）。常见的实验室异常为白细胞计数异常（46.5%）、乳酸脱氢酶（LDH）升高（42.7%）、C反应蛋白（CRP）升高（37.8%）、天门冬氨酸氨基转移酶（AST）升高（31.7%）及肌酸激酶（CK）升高（21.5%）。临床并发症包括肺炎586例（72.3%）、脑病/脑炎49例（6.0%）及心肌炎30例（3.7%）；183例儿童为危重症。危重症患者基础慢性病、白细胞增多、中性粒细胞增多、淋巴细胞减少及CRP升高的发生率较高。共19例（2.3%）死亡，8例死于脑病/脑炎；10例死于重症肺炎及急性呼吸窘迫综合征（ARDS），其中5例合并脑病/脑炎；1例死于继发性真菌性脑膜炎。
2009年甲型H1N1流感感染住院儿童可能出现多系统受累。危重症的危险因素为有基础慢性病、白细胞增多、中性粒细胞增多、淋巴细胞减少及CRP升高。重症肺炎、ARDS及脑病/脑炎并发症是主要死亡原因。
