소아에서 2009 신종 인플루엔자 A (H1N1) 바이러스 감염의 임상적 특징
Clinical and Laboratory Finding of the 2009 Pandemic influenza A (H1N1) in Children
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목 적:신종 인플루엔자 A (H1N1) 바이러스는 2009년 4월 멕시코에서 처음 확인된 후 급속히 전 세계로 확산되어 국내에서도 전국적인 유행을 보였다. 저자들은 2009-2010에 소아에서 유행한 신종 인플루엔자 A (H1N1) 바이러스 감염의 임상적, 역학적 특징을 알아보고자 하였다. 방법:2009년 8월부터 2010년 2월까지 대구파티마병원 소아청소년과에서 신종 인플루엔자 A (H1N1) 바이러스 감염으로 확진되었던 2,781명을 대상으로 하였다. 확진은 비인두 가검물을 채취하여 중합효소 연쇄반응 검사에서 양성을 보인 경우로 하였다. 의무기록지를 후향적으로 분석하였다. 결과:6,786명이 RT-PCR 검사를 받았으며 그중 2,781이 양성이었다. 158명(5.7%)이 입원치료를 받았으며, 입원군의 평균연령(5.4±3.3세)이 비입원군(7.5± 3.9세)에 비해 의미 있게 낮았다(P<0.001). 입원군 중에서 산소치료, 면역글로불린 및 스테로이드 치료, 인공호흡기 치료가 필요했던 경우는 폐렴 환자에 비해 천명음이 동반한 폐렴 환자에서 의미있게 많았으며(P=0.013), 폐렴군에서도 기관지성 폐렴에 비해 분절성, 대엽성, 간질성 혼합성, 흉수가 동반된 경우에 보다 적극적인 치료가 필요하였다(P=0.007). 확진 환자 중 1세 미만의 영아는 83명이었고 그중 71명에서 oseltamivir 처방이 이루어졌고 항바이러스제 사용으로 인한 특이한 이상 소견은 발견되지 않았다. 결 론:2009-2010에 대유행한 A형 인플루엔자 바이러스(H1N1)는 어린 연령 군에서 더 입원치료가 더 많이 필요하였다. 천명음이 동반된 폐렴경우 그리고 분절성, 대엽성, 간질성, 혼합성 폐렴이거나 흉수가 동반된 경우는 조기에 적극적인 치료가 필요하다고 생각된다.
Abstract
Purpose:2009 Pandemic influenza A (H1N1) virus was identified in March 2009 and subsequently caused worldwide outbreaks. We described the clinical and epidemiological characteristics of H1N1 influenza infection. Methods:We used retrospective medical chart reviews to collect data on the visiting patients from a single institute. H1N1 infection was confirmed in specimens with the use of a RT-PCR (real time reverse transcriptase polymerase chain reaction assay). Result:6,836 patients had H1N1 RT-PCR test, and 2,781 were confirmed with H1N1 virus infection. 158 patients (5.7%) had hospital treatment and inpatients were significantly younger (5.4±3.3 years) than outpatients (7.5±3.9 years) among H1N1 virus confirmed patients. Oxygen, steroid, immunoglobulin, ventilator treatment was provided in a substantial proportion among pneumonia patients accompanying wheezy respiration. In addition more intensive care was needed in patients accompanying segmental, lobar, interstitial, mixed pneumonia and lung effusion (27.2%) than patients with bronchopneumonia (7.3%) among H1N1 virus infection confirmed patients. Seventy-one infants had oseltamivir treatment out of 83 infants under 1 year, and no significant side effects and complications were identified. Conclusion:In 2009 pandemic influenza A (H1N1), hospital treatment was needed in younger patients. Early intensive care was needed in pneumonia patients accompanying wheezy respiration, and patients accompanying segmental, lobar, interstitial, mixed pneumonia and lung effusion.
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