北部某醫學中心144 例H1N1 新型流感病例分析

Clinical Analysis of a Novel Influenza A (H1N1) Infection in a Medical Center

本研究採用回溯性研究方法，分析台灣北部某醫學中心從2009 年5 月1 日至9 月10 日，144 位確診感染H1N1 新型流感病毒病患之臨床症狀與流行病學。其年齡介於9 個月至55.2 歲之間（中位數13.6 歲），18 歲以下佔63%，男女比1.2：1。119 位(83％) 個案在流感症狀出現48 小時內就醫。常見症狀是發燒(89.6%)、咳嗽(75.7%)、喉嚨痛(48.6%) 及流鼻水(45.8%)，其次為肌肉酸痛(38.9%) 及頭痛(23.6%)。6 位(4.2%) 有慢性疾病史。另外因併發肺炎需住院治療者有6 位(4.2%)，其中3 位在發病超過72 小時才接受Oseltamivir 治療，且1 位併發呼吸衰竭需使用呼吸器及葉克膜治療。所有H1N1 新型流感陽性個案皆無死亡病例。以即時定量聚合連鎖反應為診斷標準，244 位病患中，流感抗原快速檢驗H1N1 新型流感病毒的敏感度是91.9%、特異度49.6%。經多變項分析，流感症狀中以流鼻水(OR：2.07；P＝0.022)、有痰(OR：2.90；P＝0.016) 和流感抗原快速檢驗陽性有統計意義。研究結果發現，在H1N1 新型流感大流行期間，流感抗原快速檢驗可作為臨床診斷之參考，特別是有潛在慢性內科疾病者，有助於早期診斷早期治療，以避免重症發生。另外密切監測流感疫情變化及適當調整院感措施，配合防疫政策，是預防流感病毒在社區及醫院散播的重要策略。

This is a retrospective study describing the clinical and epidemiological characteristics of a novel influenza A virus (H1N1) infection; the study was conducted in a medical center in northern Taiwan from May 1 through September 10, 2009. During the study period, 275 patients with respiratory illnesses were screened for influenza infection by using real-time PCR. Swine H1N1 virus infection was confirmed in 144 cases. The median age of the patients was 13.6 years (range, 0.7-55.2 years), and 63% were aged below 18 years. The male-female ratio was 1.2:1. One hundred and nineteen patients (83%) sought medical care within 48 hours of the onset of symptoms. The most common symptoms seen in patients who presented to the medical center were fever (89.6%), cough (75.7%), sore throat (48.6%), rhinorrhea (45.8%), soreness (38.9%), [Author2]and headache (23.6%). Six patients (4.2%) had underlying conditions, while 6 patients were admitted because of pneumonia. Among the hospitalized patients, 3 (50%) were administered oseltamivir more than 3 days from the onset of symptoms; 1 of these patients experienced a complication of acute respiratory distress syndrome and required mechanical ventilation and extracorporeal membrane oxygenation (ECMO) support. None of the patients died. The sensitivity and specificity of the rapid antigen test were 91.9% and 49.6%, respectively. Multivariate analysis showed that rhinorrhea and sputum production were significantly correlated with positive results in rapid antigen test (OR=2.07; P=0.022 and OR=2.9; P=0.016[Author3]). Our results highlight the importance of early recognition and treatment of patients with H1N1 infection, especially in patients with underlying medical conditions. The rapid antigen test is a good screening method for early detection of influenza in an epidemic. Enhanced surveillance and appropriate infection control policy are necessary to prevent the spread of influenza virus in communities and hospitals.