Jartti Airi, Rauvala Erkki, Kauma Heikki, Renko Marjo, Kunnari Marjaana, Syrjälä Hannu
Department of Diagnostic Radiology, Oulu University Hospital, Finland.
Acta Radiol. 2011 Apr 1;52(3):297-304. doi: 10.1258/ar.2010.100379. Epub 2011 Mar 3.
Previous studies have reported chest radiographic findings of consolidation and ground-glass opacity in patients with swine-origin influenza A (H1N1). However, most of these studies include both hospitalized and outpatients.
To evaluate initial chest radiographic and CT findings of hospitalized swine flu patients, adults and children, confirmed with a real-time reverse transcriptase polymerase chain reaction (PCR) assay for H1N1 virus.
All PCR-verified swine flu patients admitted to the Department of Emergency Medicine (October 1 to December 15, 2009) at Oulu University Hospital, in Northern Finland, who underwent frontal chest radiography within 24 hours of presentation and who were hospitalized, were included. The radiographs and CT scans were assessed for the presence of pneumonia and characterized by pattern and distribution. The patients' medical records were analyzed for demographics, underlying medical conditions, the admission to the intensive care unit (ICU), initiation of mechanical ventilation or non-invasive ventilation support (NIV) and death.
Of 159 H1N1 influenza patients, 135 (85%) underwent chest radiographs at admission; 113 adults and 22 children. Findings of pulmonary infiltrates were detected in 62% (70/113) of adults and 64% (14/22) of children, being bilateral in 67% of adults and 64% of the children. The anatomic location of infiltrates was more often peripheral in adults; 42/70 (60%) vs. 4/14 (29%), P = 0.041, and diffuse among children; 9/14 (64%) vs. 26/70 (37%), P = 0.078. When the ICU and NIV patients were compared to less severe cases, on their chest radiographs four or five lobes were more often affected (65%, 11/17 vs. 34% 23/67, P = 0.029 ). The predominant radiographic findings were consolidation (93% of all patients, 91% of adults and 100% of children) and ground-glass opacity (74% of all, 77% of adults and 57% of children). Pulmonary emboli were detected by CT in 2/9 (22%) patients.
The pandemic 2009 swine influenza causes common and widely distributed infiltrates on chest radiographs among hospitalized patients, which are not peculiar to usual respiratory viral infections, and these findings can not be differentiated from usual bacterial pneumonia.
先前的研究报道了甲型H1N1猪流感患者胸部X线表现为实变和磨玻璃影。然而，这些研究大多纳入了住院患者和门诊患者。
评估经实时逆转录聚合酶链反应（PCR）检测确诊为H1N1病毒感染的住院猪流感患者（包括成人和儿童）的初始胸部X线和CT表现。
纳入2009年10月1日至12月15日在芬兰北部奥卢大学医院急诊科住院、发病24小时内接受胸部正位X线检查且经PCR验证的所有猪流感患者。对X线片和CT扫描结果进行肺炎存在情况评估，并根据影像类型和分布特征进行描述。分析患者病历中的人口统计学信息、基础疾病、入住重症监护病房（ICU）情况、是否启动机械通气或无创通气支持（NIV）以及死亡情况。
159例H1N1流感患者中，135例（85%）入院时接受了胸部X线检查；其中成人113例，儿童22例。62%（70/113）的成人和64%（14/22）的儿童检测到肺部浸润，成人双侧浸润者占67%，儿童占64%。成人浸润灶的解剖位置更常见于外周；42/70（60%）对4/14（29%），P = 0.041，而儿童中浸润灶更常见于弥漫分布；9/14（64%）对26/70（37%），P = 0.078。将入住ICU和接受NIV的患者与病情较轻的患者相比，前者胸部X线片上四或五个肺叶受累更为常见（65%，11/17对34%，23/67，P = 0.029）。主要的X线表现为实变（所有患者的93%，成人的91%，儿童的100%）和磨玻璃影（所有患者的74%，成人的77%，儿童的57%）。CT检查发现2/9（22%）的患者有肺栓塞。
2009年大流行的猪流感在住院患者胸部X线片上引起常见且广泛分布的浸润影，这并非普通呼吸道病毒感染所特有，且这些表现无法与普通细菌性肺炎相鉴别。
