Çörtük Mustafa, Acat Murat, Yazici Onur, Yasar Zehra, Kiraz Kemal, Ataman Sena Yapicioglu, Tanriverdi Elif, Zitouni Burcak, Kirakli Cenk, Ediboglu Ozlem, Tuksavul Fevziye, Dirican Adem, Celik Hale Kefeli, Ozkaya Sevket, Cetinkaya Erdogan
Department of Chest Diseases, Karabük University Faculty of Medicine, 78200 Karabük, Turkey.
Department of Chest Diseases, Adnan Menderes University Faculty of Medicine, 09010 Aydın, Turkey.
Exp Ther Med. 2017 Apr;13(4):1431-1437. doi: 10.3892/etm.2017.4153. Epub 2017 Feb 22.
Influenza A (H1N1) caused its first pandemic in 2009 in USA and Mexico. Since then, clinicians have exercised great care in order to make an early diagnosis of viral pneumonias. This is due in part to pandemic influenza A infection having greater impact on populations <65 years old than other viral strains, including seasonal influenza. Chest radiographies of those affected displayed a rapid progression of patchy infiltrates, and a large proportion of individuals required admission to intensive care units (ICU). Despite efforts, patients infected with the virus had a high mortality rate. The present multicenter study aimed to retrospectively evaluate the clinical, demographic and prognostic characteristics of patients diagnosed with epidemic viral pneumonia in Turkey. A total of 92 patients were included in the study. The Student's t-test and Chi-square tests were performed to analyze quantitative data, assuming a normal distribution, and to analyze qualitative data, respectively. Stepwise logistic regression was used to evaluate the effects of demographic variables and laboratory values on the virus mortality rate. The male/female ratio was 42/50 and the mean age was 48.74±16.65 years. A total of 69 (75%) patients were unvaccinated against influenza. The most common symptoms were cough (87%) and fever (63%). Chest computed tomography showed peripheral patchy areas of the lungs of ground glass density in 38 patients (41.3%). A total of 22 (59.4%) patients had H1N1, 5 (12.5%) patients had influenza B, and 38 (41.3%) patients met the criteria for admission to the ICU. Of these patients, 20 (52.63%) were monitored with a mechanical ventilator, with a noninvasive ventilator being adequate for 10 (26.32%) of patients. The length of stay in the ICU was 6.45±5.97 days and the duration of mechanical ventilation was 5.06±4.69 days. A total of 12 (13.04%) patients in the ICU succumbed. Logistic regression analysis revealed that among the parameters possibly associated with mortality, being an active smoker increased the risk of mortality 7.08-fold compared to other groups (P=0.005). In conclusion, viral pneumonia remains a significant health problem during the winter period. Considering the high number of ICU admissions and high rate of mortality for patients in the present study, earlier initiation of antiviral therapy is necessary. Active smoking increased mortality in viral pneumonia.
甲型H1N1流感于2009年在美国和墨西哥引发了首次大流行。从那时起，临床医生在早期诊断病毒性肺炎时格外谨慎。部分原因是甲型流感大流行感染对65岁以下人群的影响比其他病毒株更大，包括季节性流感。受影响者的胸部X光片显示斑片状浸润迅速进展，很大一部分人需要入住重症监护病房（ICU）。尽管做出了努力，感染该病毒的患者死亡率仍然很高。本多中心研究旨在回顾性评估土耳其确诊为流行性病毒性肺炎患者的临床、人口统计学和预后特征。该研究共纳入92例患者。分别采用Student's t检验和卡方检验分析呈正态分布的定量数据和定性数据。采用逐步逻辑回归分析评估人口统计学变量和实验室值对病毒死亡率的影响。男女比例为42/50，平均年龄为48.74±16.65岁。共有69例（75%）患者未接种流感疫苗。最常见的症状是咳嗽（87%）和发热（63%）。胸部计算机断层扫描显示38例患者（41.3%）肺部外周有磨玻璃密度的斑片状区域。共有22例（59.4%）患者感染H1N1，5例（12.5%）患者感染乙型流感，38例（41.3%）患者符合入住ICU的标准。在这些患者中，20例（52.63%）接受机械通气监测，其中10例（26.32%）患者使用无创通气即可。在ICU的住院时间为6.45±5.97天，机械通气时间为5.06±4.69天。ICU中共有12例（13.04%）患者死亡。逻辑回归分析显示，在可能与死亡率相关的参数中，与其他组相比，现吸烟者的死亡风险增加了7.08倍（P=0.005）。总之，病毒性肺炎在冬季仍然是一个严重的健康问题。考虑到本研究中患者入住ICU的数量众多且死亡率高，有必要更早开始抗病毒治疗。现吸烟会增加病毒性肺炎的死亡率。
