National Center for Global Health and Medicine, Tokyo, Japan.
PLoS One. 2012;7(2):e32280. doi: 10.1371/journal.pone.0032280. Epub 2012 Feb 29.
Pneumonia patients with wheezing due to influenza A(H1N1)pdm09 were frequently treated with systemic corticosteroids in Japan although systemic corticosteroid for critically ill patients with pneumonia caused by influenza A(H1N1)pdm09 has been controversial. Applicability of systemic corticosteroid treatment needs to be evaluated.
METHODS/PRINCIPAL FINDINGS: We retrospectively reviewed 89 subjects who were diagnosed with influenza A(H1N1)pdm09 and admitted to a national hospital, Tokyo during the pandemic period. The median age of subjects (45 males) was 8 years (range, 0-71). All subjects were treated with antiviral agents and the median time from symptom onset to initiation of antiviral agents was 2 days (range, 0-7). Subjects were classified into four groups: upper respiratory tract infection, wheezing illness, pneumonia with wheezing, and pneumonia without wheezing. The characteristics of each group was evaluated. A history of asthma was found more frequently in the wheezing illness (55.6%) and pneumonia with wheezing (43.3%) groups than in the other two groups (p = 0.017). Corticosteroid treatment was assessed among subjects with pneumonia. Oxygen saturation was lower in subjects receiving corticosteroids (steroid group) than in subjects not receiving corticosteroids (no-steroid group) (p<0.001). The steroid group required greater oxygen supply than the no-steroid group (p<0.001). No significant difference was found by the Kaplan-Meier method between the steroid and the no-steroid groups in hours to fever alleviation from the initiation of antiviral agents and hospitalization days. In logistic regression analysis, wheezing, pneumonia and oxygen saturation were independent factors associated with using systemic corticosteroids.
Patients with wheezing and a history of asthma were frequently found in the study subjects. Systemic corticosteroids together with early administration of antiviral agents to pneumonia with wheezing and possibly without wheezing did not result in negative clinical outcomes and may prevent progression to severe pneumonia in this study population.
在日本，流感 A(H1N1)pdm09 引起的伴喘鸣的肺炎患者常接受全身皮质类固醇治疗，而对于流感 A(H1N1)pdm09 引起的重症肺炎患者使用全身皮质类固醇则存在争议。全身皮质类固醇治疗的适用性需要进行评估。
方法/主要发现：我们回顾性分析了 89 例在大流行期间被诊断为流感 A(H1N1)pdm09 并入住东京一家国立医院的患者。患者的中位年龄（45 名男性）为 8 岁（范围，0-71 岁）。所有患者均接受抗病毒药物治疗，抗病毒药物起始时间的中位数为 2 天（范围，0-7 天）。患者被分为 4 组：上呼吸道感染、喘鸣性疾病、伴喘鸣的肺炎和不伴喘鸣的肺炎。评估了每组的特征。喘鸣性疾病（55.6%）和伴喘鸣的肺炎（43.3%）组比其他两组（p=0.017）更常伴有哮喘病史。评估了伴肺炎患者的皮质类固醇治疗情况。接受皮质类固醇治疗的患者（类固醇组）的血氧饱和度低于未接受皮质类固醇治疗的患者（非类固醇组）（p<0.001）。类固醇组比非类固醇组需要更多的氧气供应（p<0.001）。在从抗病毒药物开始治疗到发热缓解的时间和住院天数方面，使用 Kaplan-Meier 法比较类固醇组和非类固醇组之间无显著差异。在 logistic 回归分析中，喘鸣、肺炎和血氧饱和度是与使用全身皮质类固醇相关的独立因素。
在研究对象中，常发现有喘鸣和哮喘病史的患者。在本研究人群中，对于伴喘鸣和可能不伴喘鸣的肺炎，全身皮质类固醇联合早期抗病毒药物治疗并未导致负面临床结局，并可能预防病情进展为重症肺炎。
