Clinical Features of Pneumonia Caused by 2009 Influenza A(H1N1) Virus in Beijing, China

被引:51
作者
Bai, Lu [2 ]
Gu, Li [2 ]
Cao, Bin [2 ,5 ]
Zhai, Xiao-Li [3 ]
Lu, Min [4 ]
Lu, Yong [1 ]
Liang, Li-Rong [1 ]
Zhang, Lei [3 ]
Gao, Zi-Fen [4 ]
Huang, Ke-Wu [1 ]
Liu, Ying-Mei [2 ]
Song, Shu-Fan [2 ]
Wu, Lin [2 ]
Yin, Yu-Dong [2 ]
Wang, Chen [1 ,5 ]
机构
[1] Capital Med Univ, Beijing Inst Resp Med, Beijing Chao Yang Hosp, Dept Resp & Intens Care Med, Beijing 100020, Peoples R China
[2] Capital Med Univ, Beijing Chao Yang Hosp, Dept Infect Dis & Clin Microbiol, Beijing 100020, Peoples R China
[3] Capital Med Univ, Beijing Chao Yang Hosp, Dept Radiol, Beijing 100020, Peoples R China
[4] Peking Univ, Dept Pathol, Sch Basic Med Sci, Beijing 100871, Peoples R China
[5] Beijing Key Lab Resp & Pulm Circulat, Beijing, Peoples R China
关键词
ACUTE RESPIRATORY SYNDROME; CRITICALLY-ILL PATIENTS; PULMONARY-FUNCTION; A H1N1; EXERCISE CAPACITY; ADULT PATIENTS; UNITED-STATES; LUNG-CHANGES; INFECTION; AUSTRALIA;
D O I
10.1378/chest.10-1036
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Data on symptoms and radiographic changes in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) pneumonia during convalescence have not been reported. Methods During October 26, 2009, and January 23, 2010, adult patients with pneumonia with laboratory-confirmed or clinically suspected A(H1N1) infections were observed for clinical characteristics, high-resolution chest CT scan, and lung function test changes during acute and 3-month convalescent phases. Results: Of the 65 case subjects, the median age was 41 (interquartile range [IQR], 28-57) years, 60.0% were men, and 55.4% had at least one underlying medical condition. Sixty-two patients started oseltamivir therapy within a median of 5 (IQR, 4-6) days from the onset of illness, and 31 received IV corticosteroids. ARDS developed in 33 patients, and 24 were treated initially with noninvasive positive pressure ventilation (NPPV). In this group, NPPV was successful in 13 patients (54.2%). Nine patients died at a median of 16 (IQR, 10-24) days after onset of illness. Multivariate Cox regression identified two independent risk factors for death: progressive dyspnea after resolution of fever (relative risk, 5.852; 95% CI, 1.395-24.541; P = .016) and a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score on presentation (relative risk for each point, 1.312; 95% CI, 1.140-1.511; P <.001). At 3-month follow-up of survivors with A(H1N1), ground-glass opacities were still present, although diminished, in 85.7%, and diffusing capacity for carbon monoxide was mildly reduced in 61.5%. Conclusions: Ground-glass opacities and decreased diffusing capacity were the main abnormalities observed at 3-month follow-up of survivors of A(H1N1). CHEST 2011; 139(5):1156-1164
引用
收藏
页码:1156 / 1164
页数:9
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