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Objective:Summarizing and analysising the risk factors of severe H1N1 influenza related pneumonia, to find out the effect of obesiy on prognosis of patients with severe pneumonia, so we can diagnosis and prevent it early.Methods:1. Subjects 32 patients who were diagnosed with severe H1N1 influenza related pneumonia from october 2009 to marth 2010 were related from hospital of the authors in ChangChun, China. Collect the clinical information of the patients, and preliminary analysis the risk factors of severe H1N1 influenza related pneumonia.2. The patients were divided according to BMI, pregnancy, comorbidity, age, residency, DNA test results of A/H1N1. Comparison the basic situation, conditions and prognosis score, and the indicators of lung, heart, liver, kidney, blood lipids, coagulation function.3. Statistics:all the data were expressed as means±SD. The enumeration datas were analysis by x2 test. The differences between the groups were analyzed by t-test. If the datas were normally distributed, skewed distribution of data using Mann-Whitney U test. Adverse outcomes related factors were performed using Logistic regression model. All statistical analysis were performed using SPSS 13.0 for Windows software package.Results:1. There were significant differences between the obesity and non-obesity patients in APACHEⅡscore, SOFA score and SIRS score (p< 0.05). The APACHEⅡscore had a significantly correlation with BMI (p <0.05, r=0.608), regression equation y=17.954+0.781 x. The chest radiograph scores, the optimal PEEP, ALT, ALB, heart rate, CK, LDH, PT, APPT, TC, HDL between the two groups had significant difference (p<0.05). The obesity patients had more incidence of MODS, gastrointestinal bleeding and cardiac arrhythmia, the difference had statistically significant (p<0.05).2. There were significant difference between the pregnancy and non-pregnancy patients in age, the time from onset of symptoms to treatment, TBIL, TC, BUN, PT, FIB (p<0.05), There were no significant differences in other laboratory test indexs. The APACHEⅡscore and SOFA score of obesity pregnancy patients with severe pneumonia were higher than that in non-obesity pregnancy patients, they had significant differences (p<0.05), but there were no significant differences in the mortality risk factors and SIRS score. The linear regression analysis showed that APACHE II score had a significant correlation with BMI (p<0.05, r=0.669), regression equationy 17.174+0.921 x. There were significant between the obesity pregnancy and non-obesity pregnancy patients with sever pneumonia in oxygenation index, AST, CK, CK-MB, LDH, TC, LDL (p<0.05), but there were no significant differences in other laboratory index.3.There were significant differences between APACHEⅡscore, PT, APPT, HDL, LDL between the patients complicate with basic diseases and without basic disease(p<0.05). There were no significant differences in other areas.4. The patients who were obesity or had basic disease had higher mortality than other patients (p<0.05). Multivariate Logistic regression analysis showed:obesity (OR=18.541) and basic diseases (OR=22.16) were risk factors of severe H1N1 influenza related pneumonia.Conclusion: 1. The obesity patients with poor prognosis than non-obesity patients of severe H1N1 influenza related pneumonia, and with the increase of BMI, APACHE II score increased. The obesity patients in severe H1N1 influenza related pneumonia had abnormal in lung, liver, heart, blood lipid regulation and coagulation function, and they had more incidence of MODS, gastrointestinal bleeding and cardiac arrhythmia.2. The time from onset of symptoms to treatment in pregnancy patients were long, so they had a poor prognosis. The obesity patients in pregnancy with severe H1N1 influenza related pneumonia had poor prognosis and the APACHE II score had a significantly correlation with BMI of the patients. Pregnant patients comply with lung、heart、blood lipid and coagulation when severe H1N1 influenza related pneumonia occurred.3. The patients who had comorbidities had poorer prognosis than the patients who did not have, and they easily complied with abnormal of coagulation and blood lipid.4. In this study, obesity and comorbidities were independent risk factors in severe H1N1 influenza related pneumonia.
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