北京地区400例甲型H1N1流感患者流行病学及临床分析

【】　目的　了解北京地区400例新型甲型H1N1流感患者的流行病学和临床特征，总结规律，进一步指导临床诊治。　方法　2009年5-12月期间，收治400例甲型H1N1流感确诊病例，主要采用描述性流行病学方法对患者资料进行回顾性分析，并运用单因素方差分析的方法对结果进行检验。　结果　患者以青年和儿童人群为主，47.0%的患者有明确甲型H1N1流感接触史，主要症状包括发热（98.8%）、咳嗽（85.8%）、咽痛（58.5%）。咽部充血（94.0%）和扁桃体肿大（49.5%）为主要体征。外周血白细胞正常或偏低，349例（82.3%）患者血清铁降低，268例（72.6%）患者C反应蛋白升高。在发病后不同时间内给予奥司他韦治疗的患者发热持续时间和咽拭子的阴转时间有显著差异（P<0.001）。　结论　新型甲型H1N1流感发病多以青年和儿童人群为主，以流感样症状为主，多数症状轻微，预后良好，C反应蛋白和血清铁的变化可能对于早期诊断有指导价值，奥司他韦早期抗病毒治疗可以缩短病程。？【Abstract】　Objective　ToinvestigatetheclinicalandepidemiologiccharacteristicsofpandemicinfluenzaA(H1N1)virusinfectioninBeijing.　Methods　Theepidemiologicalinformationandclinicalcharacteristicsof400patientswithpandemicinfluenzaA(H1N1)virusinfectionhospitalizedinBeijing302HospitalfromMaytoDecember,2009wereanalyzedretrospectivelybydescriptiveepidemiology.One-wayANOVAwasusedtoassesstheresults.　Results　H1N1virusinfectionpreferentiallyaffectedadolescentsandyoungadults.Themeanageofthepatientswas23years.Atotalof189(47.0%)ofthepatientshadanidentifiableepidemiologiclinktoanotherconfirmedpatient.Themostcommonsymptomswerefever(98.8%),cough(85.8%)andsorethroat(58.5%).Themainphysicalsignswerepharyngealportioncongestion(94.0%)andantiadoncus(49.5%).Thenumberofleukocytesintheperipheralbloodwasnormalorlow.ThedecreasedserumironandelevatedC-reactionproteinwerefoundin82.3%and72.6%ofthepatients.Therewassignificantdifferenceinthedurationoffeverandviralsheddingfromthroatswabsamongthepatientswhoaccepttheantiviralmedicationwithinthedifferenttime.　Conclusion　H1N1virusinfectionpreferentiallyaffectsadolescentsandyoungadults,andpresentswithinfluenza-likeillness.TheclinicalcourseofH1N1virusinfectionisgenerallymild.ThechangeofC-reactionproteinandserumironmaybefavorableforthediagnosisofH1N1.Earlyantiviraltreatmentmayshortenthedurationoffeverandviralshedding.