Gao Jing, Chu Weili, Duan Jiali, Li Junlu, Ma Wentao, Hu Chunling, Yao Mengying, Xing Lihua, Yang Yuejie
Department of Respiratory Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Respiratory Intensive Care Unit, The Sixth People's Hospital of Zhengzhou, Zhengzhou, China.
Front Mol Biosci. 2021 Jun 8;8:640763. doi: 10.3389/fmolb.2021.640763. eCollection 2021.
Influenza virus is a common pathogen causing community-acquired pneumonia. After H1N1 infection, some patients present with rapid disease progression and various respiratory complications, especially immunocompromised patients and pregnant women. However, most patients have a favorable prognosis. Influenza viruses infect respiratory epithelial cells, leading to diffuse alveolar damage (DAD), which could induce secondary bacterial or fungal infections that could lead to serious complications, such as acute respiratory failure, severe pneumonia, pneumothorax, mediastinal emphysema, acute respiratory distress syndrome (ARDS) and post-ARDS fibrosis. The short-term mortality rate of ARDS is decreasing, and understanding survivors' posthospitalization outcomes is very important. Our aim was to evaluate the outcomes of 69 patients who survived H1N1 pneumonia with severe respiratory complications and abnormal CT findings and developed post-ARDS pulmonary fibrosis. The 280 inpatients included in this trial had been diagnosed with H1N1 infection that was confirmed by pharyngeal sputum or swab tests. The data were collected from January 2018 to January 2020 in the First Affiliated Hospital of Zhengzhou University and the Sixth People's Hospital of Zhengzhou. Of these patients, 232 had CT findings indicating pulmonary fibrosis after H1N1 infection, and 69 survived and consented to participate in this study. 6°months after diagnosis, the 69 surviving patients were interviewed and underwent physical examinations, CT scans, 6°min walk tests, and quality-of-life evaluations (SF-36). We analyzed the baseline variables and six-month outcomes of post-ARDS pulmonary fibrosis in patients with H1N1 pneumonia. Of the 69 surviving patients with post-ARDS pulmonary fibrosis, there were 24 females and 45 males, with a mean age of 53.7 ± 16.8°years; 18 patients (26%) had no underlying disease, and 14 (20%) patients had more than one underlying disease. The distance walked in 6°min increased from an average of 451.9°m at 3°months to 575.4°m at 6°months; the mean 36-Item Short Form Survey (SF-36) physical function score increased from an average of 75.3 at 3°months to 77.5 at 6°months; and the average CT score decreased from 31.3 at 3°months to 14.8 at 6°months. Treatment with systemic corticosteroids and the presence of an underlying disease were related to the CT score and the distance walked in 6°min. Among the survivors with pulmonary fibrosis after H1N1 influenza, the 6°min walk test and CT scores continued to be affected after 6°months. The 6°min walk distance and imaging findings improved during the first 6°months. The health-related QoL (HRQoL) scores of H1N1 pneumonia survivors were lower than those of sex- and age-matched controls.
流感病毒是引起社区获得性肺炎的常见病原体。H1N1感染后，一些患者病情进展迅速并出现各种呼吸道并发症，尤其是免疫功能低下的患者和孕妇。然而，大多数患者预后良好。流感病毒感染呼吸道上皮细胞，导致弥漫性肺泡损伤（DAD），这可能引发继发性细菌或真菌感染，进而导致严重并发症，如急性呼吸衰竭、重症肺炎、气胸、纵隔气肿、急性呼吸窘迫综合征（ARDS）以及ARDS后纤维化。ARDS的短期死亡率正在下降，了解幸存者出院后的结局非常重要。我们的目的是评估69例H1N1肺炎伴严重呼吸道并发症且CT检查结果异常并发生ARDS后肺纤维化的幸存者的结局。本试验纳入的280例住院患者已通过咽拭子或痰液检测确诊为H1N1感染。数据收集于2018年1月至2020年1月期间在郑州大学第一附属医院和郑州市第六人民医院。在这些患者中，232例CT检查结果显示H1N1感染后存在肺纤维化，69例存活且同意参与本研究。诊断后6个月，对69例存活患者进行了访谈，并进行了体格检查、CT扫描、6分钟步行试验以及生活质量评估（SF-36）。我们分析了H1N1肺炎患者ARDS后肺纤维化的基线变量和6个月结局。在69例ARDS后肺纤维化的存活患者中，女性24例，男性45例，平均年龄为53.7±16.8岁；18例患者（26%）无基础疾病，14例患者（20%）有不止一种基础疾病。6分钟步行距离从3个月时的平均451.9米增加到6个月时的575.4米；36项简明健康状况调查（SF-36）身体功能评分从3个月时的平均75.3分增加到6个月时的77.5分；平均CT评分从3个月时的31.3分降至6个月时的14.8分。全身使用糖皮质激素治疗以及存在基础疾病与CT评分和6分钟步行距离有关。在H1N1流感后发生肺纤维化的幸存者中，6个月后6分钟步行试验和CT评分仍受影响。6分钟步行距离和影像学表现在前6个月有所改善。H1N1肺炎幸存者的健康相关生活质量（HRQoL）评分低于性别和年龄匹配的对照组。
