Klimova E A, Iushchuk N D, Karetkina G N, Boĭtsov P V, Serobian A G, Kelli E I, Malyshev N A, Golokhvastova N O, Esaulova M R, Karchevskaia N A, Avdeev S N
Ter Arkh. 2010;82(11):15-8.
To study the outcomes of severe pandemic influenza A/H1N1/2009.
The study enrolled 24 patients, including 8 males and 16 females (10 of whom were pregnant), aged 17 to 58 years, with a laboratorily verified diagnosis of pandemic influenza A/H1N1/2009, treated at the intensive care unit for the significant symptoms of acute respiratory failure (RF). Real-time RT-PCR was used to verify the diagnosis. Organs and tissues from deceased patients were histologically studied; chest computed tomography, body plethysmography, fibrobronchoscopy, breath test, and 6-minute walk test were performed in the late period.
Within the first 30 days, a fatal outcome caused by therapy-resistant progressive RF was observed in 33% of the patients with pandemic influenza treated at the intensive care unit. Diffuse alveolar damage caused by influenza virus, which gives rise to hyaline membranes, underlies RF. Lung tissue fibrosis formed in recovered patients.
The severity of pandemic influenza A/H1N1/2009 was determined by massive bilateral pneumonia, interstitial (alveolar) pulmonary edema, formation of diffuse bilateral lung fibrosis at the outcome of severe virus pneumonia (acute respiratory distress syndrome) with a decrease in vital and diffusing capacities, thereby generating a need to follow up this patient category and, possibly, to elaborate special rehabilitation programs.
研究2009年甲型H1N1大流行性流感的严重病例转归情况。
本研究纳入了24例患者，其中男性8例，女性16例（10例为孕妇），年龄17至58岁，经实验室确诊为2009年甲型H1N1大流行性流感，因急性呼吸衰竭（RF）的显著症状在重症监护病房接受治疗。采用实时逆转录聚合酶链反应（RT-PCR）进行诊断验证。对死亡患者的器官和组织进行组织学研究；在后期进行胸部计算机断层扫描、人体体积描记法、纤维支气管镜检查、呼气试验和6分钟步行试验。
在最初30天内，在重症监护病房接受治疗的大流行性流感患者中，33%出现了因治疗抵抗性进行性RF导致的致命结局。流感病毒引起的弥漫性肺泡损伤导致透明膜形成，是RF的基础。康复患者形成了肺组织纤维化。
2009年甲型H1N1大流行性流感的严重程度由大量双侧肺炎、间质性（肺泡性）肺水肿、严重病毒肺炎（急性呼吸窘迫综合征）结局时双侧弥漫性肺纤维化形成以及肺活量和弥散功能下降所决定，因此需要对这类患者进行随访，并可能制定特殊的康复计划。
