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Object:The influenza A(H1N1) is a new respiratory infectious disease. It outbreaked in Mexico in March, 2009, and spread quickly all over the world. Through the comprehensive analysis of clinical manifestation, laboratory examination results, radiological material, treatment and outcome situation of influenza A(H1N1) cases, we want to summarize its characteristics, and provide experience of the treatment of viral pneumonia with influenza A(H1N1).Methods:We observed 59 cases whose influenza A(H1N1) virus nucleic acid tests were positive. They were admitted in the second hospitalof HeBei medical university from 3 December 2009 to 12 February 2010. We analysed their clinical symptoms, laboratory examination results and radiological material. What’s more, we used automatic biochemistry analyzer to test enzymology related indicators,automaticelectrophoresis analyzer to test LDH-ISO, flow cytometry to analysethe immunological indexes.The MB-80 microbial dynamic fast detection system and GKT-5M Set dynamic fungi detection kit were usedto detect the content of 1-3-β-D glucan. The statistical software SPSS13.0 was used to analyze datas.Results:1. General informationAmong the 59 cases, 41 cases (69.49%) were female, 18 cases (30.51%) were male. The characteristic of distribution of age group as fllows:<10: 1case(1.69%), 10～19: 3cases(5.08%), 20～29: 29 cases(49.15%), 30～39: 6cases(10.17%), 40～49: 6cases(10.17%), 50～59: 6cases(10.17%), 60～69: 3cases(5.08%), 70～79: 4cases(6.78%), >80: 1case(1.69%). Among all risk factors, 42 cases(71.19%) were overweight or obesity, 30 cases(50.85%)were pregnant or parturient, 22 cases(37.29%)were complicated by other coexisting conditions.2. Clinical featuresThe most common symptom was fever(59cases, 100.00%). Its fluctuating range is 2 ~ 15 days, and the median number is 5 days.The highest temperature is between 37.8℃and 41.5℃. The median number is 39℃. The other concomitant symptoms were cough(89.83%), sputum production(67.80%), chest tightness shortness of breath(69.49%). Hemoptysis or blood-stained sputum was infrequent(8.47%). Among the clinical signs, 40 cases (67.80%)were with rales, 22 cases(37.29%)were associated with rhonchi and moist rale at the same time.3. Laboratory tests3. 1. blood routine examinationThe leukocytes of 19(32.20%)cases increased. 52(88.14%)cases were with Neutrophils increased. 54(91.53%)cases were with lymphocytes decreased.Compared with the recovery stage, leukocytes(9.52±3.58×109/L vs 7.83±2.73×109/L,P<0.05)and the percentage of neutrophils (85.32±5.48% vs 68.63±12.58%,P<0.01) increased significantly. The percentage of lymphocytes (11.56±6.18% vs 22.70±10.71%,P<0.01) decreased. There is a statistical significance.3. 2. EnzymologyThe most common increasing of enzymology index was LDH( 50cases, 84.75%). Secondly,α-HBDH (37cases, 62.71%), AST ( 36 cases, 61.02%), MYO (19 cases, 32.20%), CK (19 cases, 32.20%), ALT (19 cases, 32.20%), CK-MB (17 cases, 28.81%), AMY(4 cases, 6.78%). Compared with the recovery stage, CK (363.04±139.35U/L vs 54.97±19.96U/L, P<0.01), CK-MB(37.86±17.60 IU/L vs 13.39±5.47 IU/L,P<0.01),α-HBDH(361.36±176.18IU/L vs 234.48±75.06 IU/L, P<0.01), MYO(63.57±39.37ng/ml vs 24.98±14. 05ng/ml, P<0.01), AST(69.96±36.14U/L vs 24.24±11.94U/L,P<0.01), ALT(41.32±21.74U/L vs 19.16±8.81U/L, P<0.01)increased significantly, There is a statistical significance.LDH and its isoenzymes:Compared with the recovery stage, LDH(524.68±198.98 IU/L vs 274.92±96.48IU/L,P<0.01), LDH1%( 541.55±3.79 vs 35.04±2.06,P< 0.01), LDH3%(16.66±1.54 vs 13.91±2.27 , P < 0.05), LDH5%(6.04±1.98 vs 2.72±0.65, P<0.01), LDH1/LDH2(1.43±0.23 vs 0.81±0.08,P < 0.01), LDH5/LDH4(1.30±0.24 vs 0.54±0.12 , P <0.01)increased significantly, LDH2%(43.21±9.83% vs 36.82±11.46, P<0.01)decreased significantly, There is a statistical significance. LDH4%(4.63±1.98 vs 5.28±1.45,P>0.05)didn’t increase, There is no statistical significance.3. 3. ElectrolytesThe number of the electrolytes subgroup is 36(61.02%). Hyponatremia:24 cases(40.68%); Hypokalemia:12cases(20.33%). Compared with the recovery stage, Na+(133.02±3.01mmol/L vs 139. 84±4.46mmol/L)andK+ (3.76±0.54mmol/Lvs4.28±0.44mmol/L)decreased obviously, There is a statistical significance.3. 4. Immunology examination31 cases (52.54%)were with CD3+T% decreased;27 cases (45.76%) were with CD4+T% decreased; 23cases(38.98%) were with CD8+T% decreased.Compared with the recovery stage, CD3+T%(56.32±15.22% vs 68.53±8.41%, P<0.01), CD4+T%(32.84±11.66% vs 40.37±6.12%,P<0.01)and CD8+ T%(23.69±8.10% vs 26.53±8.17%,P<0.01)decreased obviously, There is a statistical significance. 3. 5.Blood gas analysisHypoxemia: 55 cases(93.22%), typeⅠrespiratory failure:37 cases (62.71%), ARDS: 22 cases (37.29%).3. 6. Etiology inspectionPneumonia crayresearch (10cases, 16.95%)is the most common in germiculture, followed by acinetobacter baumannii (8 cases, 13.56%), pseudomonas aeruginosa (3 cases, 5.08%), corynebacteria (3 cases, 5.08%)and eosinophilic malt the pseudomonas (2 cases, 3.39%)is rare. Fungi smear and training are all white candida(6 cases, 10.17%).4. Imaging materialAll patients appear exudative high-density shadow in lung imaging, flake or patchy shadows of the majority, and mostly bilateral lesions (50 cases, 84.75%). 59 patients were Involving 2 and above lobe. The bilateral pleural effusion(20 cases, 33.90%)and the unilateral pleural effusion(14 cases, 23.73%)were common.5. Multiple organ damageIn this study, all of the cases were with viral pneumonia. 19 cases (32.20%)were with lung and heart injury simultaneously. 16 cases (27.12%) were with lung and liver injury. 4 cases (6.78%) were with lung and kidney injury. 1 case (1.69%) was with lung and nervous system injury. What’s more, 13 cases(22.03%) were with lung, heart and liver injury. 4 cases(6.78%) were with lung, heart and kidney injury.Conclusion:1 pregnancy, obesity, underlying diseases are the high risk factors of the influenza A(H1N1);2 The clinical symptoms such as dyspnea, hypoxemia are prominent features of the cases with viral pneumonia of influenza A(H1N1). The pulmonary lesionsare wide, and progress rapidly. The secondary bacterial and fungal infection is common.3 The proportion of peripheral blood lymphocyte decreases. The T achroacyte subgroups such as CD3+T、CD4+T、CD8+T decrease obviously. It points out the decline of immune function of the cases with influenza(H1N1);4 The multiple organ damage such as lung, heart, liver etc. happens to the cases with influenza(H1N1). The main aspects are the increase of CK, CK-MB, LDH,α-HBDH, MYO, AST and ALT. The increase of LDH is mainly from lung, heart and liver. The damage of lung, heart and liver can be reversed.
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