我国重症及危重症甲型H1N1流感住院肥胖患者临床分析  

Clinical analysis of obese patients with severe or critical 2009 pandmic influenza A

作　　者：杨淑乔[1,2] 李晓莉[3] 于晓敏[1,2] 曲久鑫[1,2] 李辉[1,2] 刘波[2] 曹彬[1,2] 王辰[2,4] 

机构地区：[1]首都医科大学附属北京朝阳医院感染和临床微生物科,北京100020 [2]北京呼吸疾病研究所,北京100020 [3]首都医科大学附属北京潞河医院,北京101149 [4]卫生部北京医院呼吸和危重症医学科,北京100730

出　　处：《中国实用内科杂志》2013年第5期372-376,共5页Chinese Journal of Practical Internal Medicine

基　　金：新世纪优秀人才支持计划课题(NCET-10-0006);国家自然科学基金重点项目(81030032/H19);国家自然科学基金面上项目(81271840;81070005/H0104)

摘　　要：目的探讨超重、肥胖甲型H1N1流感重症和危重症患者的临床特征及和正常体重患者的差异,以期为该类患者的诊疗提供更多科学依据。方法收集2009年9—12月中国27个省市自治区收治的住院重症和危重症甲型H1N1流感成人患者资料,按体重指数分正常体重、超重和肥胖组,用SPSS 17.0进行临床资料集指标比较和分析。结果纳入研究纳入研究669例,正常体重者308例(46.0%),超重者230例(34.4%),肥胖者131例(19.6%)。肥胖组合并高血压比例高于正常体重组(26.7%对14.0%,P=0.005)。随着体重指数的增加,咯血发生率升高(组间比较,均P<0.05)。肥胖组呼吸频率较正常体重组患者更快[23次/min(20～28次/min)对20次/min(20～24次/min),P=0.001]。此外,超重组和肥胖组患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酐(Cr)水平高于正常体重组(P<0.01)。尽管3组间病死率差异无统计学意义,但肥胖组患者比正常体重组患者呼吸衰竭发生率以及ICU入住率更高(P<0.001),住院时间也明显延长(P<0.001)。结论重症及危重症甲型H1N1流感住院肥胖患者呼吸困难更明显,组织器官损伤更重,更易发生呼吸衰竭。Objective To analyse the clinical aspects of overweight and obese patients with severe or critical 2009 pandmic influenza A （ H1 N1 ） in China. Methods We collected data on adult patients hosptalized for severe or critical 2009 H1 N1 virus infection from Sep 1 st,2009 to Dec 31 st ,2009 in the mainland of China. Patients were divided into groups of normal weight, overweight, or obesity group based on BMI. Results In the 669 patients analysed,308cases were with normal weight （46. 0% ） ,230 cases were overweight （34.4%） ,and 131 cases were obese （ 19. 6% ）. Patients who were obese were more likely to be complicated with hypertension than normal weight patients （26. 7% vs 14. 0%, P = 0. 005 ）. The frequency of hemoptysis was obeviously higher in obesity group than normal weight group（ P 〈 0. 001 ）. The level of alanine transaminase （ALT）, aspartate aminotransferase （AST）,lactase dehydrogenase （LDH）,creatine kinase （CK） and creatinine （Cr） were much higher in the overweight or obesity group. Although no statistical significance in mortality was found among the three groups,the incidence of respiratory failure and ICU adimission rate were much higher in the obesity group than in normal weight group （ P 〈 0. 001 ）, besides, the length of hospitalisition were much longer（ P 〈 0. 001 ）. Conclusion Obese patients with severe or critical 2009 pandmic influenza A （H1N1）were more likely to develop dyspnea, tissue and organ damage, and have higher incidence of respiratory failure.

关 键 词：甲型H1 N1流感 成人 重症 肥胖 超重 

分 类 号：R373.13[医药卫生—病原生物学]