Zhang Qing, Zhao Zhi-Wei, Xing Zhi-Li, Zhang Bo, Zheng Hong-Fei, Sun Li-Xin
Department of Respiratory Disease, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China.
Department of Emergency, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China.
Biomed Rep. 2013 Sep;1(5):723-726. doi: 10.3892/br.2013.128. Epub 2013 Jun 3.
Pneumonia is the most common complication of influenza A (H1N1). However, there has been no identification of any single initial symptom as an independent risk factor. In 2009, 206 patients were diagnosed with H1N1 in the Chengde area, China and they were assembled in the Chengde Hospital for Infectious Diseases. The diagnosis and treatment were performed in accordance with the Protocol for Diagnosis and Treatment of Influenza A (H1N1) (2009, third edition), issued by the General Office of the Ministry of Health, with detailed records by the medical staff assigned by the Bureau of Health of the Chengde government. All the patients had viral nucleic acid-positive throat swabs detected with quantitative reverse transcription polymerase chain reaction (qPCR). Based on the final imaging findings, patients were divided into the pneumonia and non-pneumonia groups for this case control study. The univariate analysis demonstrated that the ratios of patients aged 0-5 and ≥45 years, with underlying diseases, with initial symptoms including cough, expectoration and dyspnea and with onset-to-treatment interval of >48 h were higher in the pneumonia compared to the non-pneumonia group (P<0.001, P<0.001, P=0.018, P<0.001, P<0.001 and P<0.001, respectively). The multivariate logistic regression analysis demonstrated that age 0-5 years, presence of underlying diseases, expectoration as the initial symptom and onset-to-treatment interval of >48 h were the independent risk factors for pneumonia with relative odds ratios (OR) and 95% confidence intervals (95% CIs) of 6.120 and 1.779-21.088, 11.188 and 2.021-61.935, 5.263 and 2.042-13.562, and 22.873 and 6.110-85.631, respectively (P<0.01). Therefore, it is recommended that patients with H1N1 presenting with expectoration as the initial symptom be treated with caution during influenza pandemics.
肺炎是甲型H1N1流感最常见的并发症。然而，尚未发现任何单一初始症状可作为独立危险因素。2009年，中国承德地区有206例患者被诊断为H1N1流感，并被收治于承德市传染病医院。诊断和治疗均按照卫生部办公厅发布的《甲型H1N1流感诊疗方案（2009年第三版）》进行，承德市政府卫生局指定的医务人员进行了详细记录。所有患者经定量逆转录聚合酶链反应（qPCR）检测咽喉拭子病毒核酸均呈阳性。根据最终影像学检查结果，将患者分为肺炎组和非肺炎组进行该病例对照研究。单因素分析显示，与非肺炎组相比，肺炎组中0 - 5岁及≥45岁、有基础疾病、初始症状包括咳嗽、咳痰和呼吸困难以及发病至治疗间隔>48小时的患者比例更高（分别为P<0.001、P<0.001、P = 0.018、P<0.001、P<0.001和P<0.001）。多因素logistic回归分析显示，0 - 5岁、有基础疾病、初始症状为咳痰以及发病至治疗间隔>48小时是肺炎的独立危险因素，相对比值比（OR）及95%置信区间（95%CI）分别为6.120及1.779 - 21.088、11.188及2.021 - 61.935、5.263及2.042 - 13.562、22.873及6.110 - 85.631（P<0.01）。因此，建议在流感大流行期间，对以咳痰为初始症状的H1N1流感患者谨慎治疗。
