2009年H1N1全球大流行孕产妇和儿童感染患者流行病学特征的系统评价  

Epidemiological characteristics of pregnant females and children with H1N1-infected during the global pandemic in 2009:a systematic review

作　　者：张萌 唐军[1,2] 何洋 李文星[1,2] 岳艳 胡鹏[1,2] 曾燕 熊涛 母得志 李幼平[3] ZHANG Meng;TANGJun;HE Yang;LI Wenxing;YUEYan;HU Peng;ZENGYan;XIONG Tao;MU Dezhi;LI Youping(Department of Pediatrics,West China Second Hospital,Sichuan University,Chengdu 610041,P.R.China;Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Chengdu 610041,P.R.China;Chinese Evidence-based Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西第二医院儿科,成都610041 [2]出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [3]四川大学华西医院中国循证医学中心,成都610041

出　　处：《中国循证医学杂志》2020年第6期661-671,共11页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价2009年H1N1全球大流行期间感染孕产妇和儿童的流行病学特征。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、VIP和WanFang Data数据库,搜集涉及2009年大流行期间H1N1感染孕产妇和儿童的临床研究,检索时限均从2009年1月1日至2020年2月17日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,描述性分析其流行病学特征。结果共纳入33个研究,包括儿童感染944例(含新生儿5例),孕产妇感染2 416例。定性系统评价分析结果显示:儿童病例年龄0~18岁,男女比例1.2∶1,18.8%(80/425)有密切接触史。主要症状表现为发热、咳嗽,部分出现头痛、呕吐等症状,大部分患儿接受了奥司他韦抗病毒治疗(545/807,67.5%),死亡6例(6/861,0.7%)。孕产妇病例主要症状为发热、咳嗽、咽痛、肌肉疼痛,部分出现乏力、头痛、腹泻等,大部分患者接受了抗病毒治疗(1 571/1 783,88.1%),死亡病例178例(178/2 335,7.6%)。死胎48例(48/966,5.0%),活产婴儿死亡9例(9/494,1.8%)。新生儿中5例被发现核酸检测阳性,其中早产儿4例。传播方式为密切接触传播3例(包括1例与患病医护人员接触感染),母婴垂直传播1例,另1例不详。新生儿H1N1感染主要临床表现为呼吸困难,均使用奥司他韦治疗,4例痊愈,1例死亡。结论孕产妇和儿童是甲型H1N1流感的严重并发症高风险群体,妊娠期H1N1感染增加了不良妊娠结局的风险。儿童与孕产妇H1N1感染症状与成人相似,以呼吸系统和全身症状为主。奥司他韦、扎那米韦为有效抗病毒药物。Objective To analyze the clinical data of pregnant females and children infected with H1 N1 during the global pandemic in 2009,and summarize the epidemiological characteristics.Methods PubMed,EMbase,The Cochrane Library,CNKI,VIP and WanFang Data databases were searched to collect studies on H1 N1 infection in pregnant females and children during the 2009 pandemic from January 1 st,2009 to February 17 th,2020.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies,then,epidemiological characteristics were descriptively analyzed.Results A total of 33 studies involving 939 children,5 newborns and 2416 maternal infections were included.The results showed that the age span of children was 0 to 18,the male-to-female ratio was 1.2:1,and the history of close contact accounts was 18.8%(80/425).The primary symptoms were fever,cough,headache,vomiting and other symptoms in some children.More than half of the children received oseltamivir antiviral treatment(545/807,67.5%),and 6 died(6/861,0.7%).The primary symptoms of pregnant females were fever,cough,sore throat,muscle pain,fatigue,headache,diarrhea,and so on.The majority of patients received antiviral therapy(1571 to1783,88.1%).A total of 178 mortalities(178/2335,7.6%),48 stillbirths(48/966,5.0%),and 9 live birth mortalities(9/494,1.8%)were reported.All 5 newborns were positive for RT-PCR detection,including 4 premature infants.The mode of transmission was close contact in 3 cases(including 1 case in contact with sick medical staff),1 case of vertical transmission from mother to child,and 1 case of unknown.The primary clinical manifestation of newborns was dyspnea.After treatment with oseltamivir,4 cases were cured and 1 case deceased.Conclusions Pregnant females and children are at high risk of serious complications of H1 N1 influenza.H1 N1 infection in pregnancy is associated with an increased risk of adverse pregnancy outcomes.The symptoms of H1 N1 infection in children and pregnant females are similar to those in adu

关 键 词：H1N1流感 儿童 孕产妇 新生儿 流行病学特征 系统评价 

分 类 号：R714.251[医药卫生—妇产科学] R725.1[医药卫生—临床医学] R181.3