Objective To explore the clinical and chest CT features of influenza A (H1N1) in children with acute leukemia. Methods Clinical manifestations and chest CT findings in six children with acute leukemia suffering from influenza A ( H1N1 ) were analyzed in Wenzhou area from November of 2009 to January of 2010. The diagnosis was confirmed by epidemiology, clinical, laboratory and radiological examinations. Among all cases, one was a boy and the others were girls ranged from 2 to 15 years old. Results All 6 cases had no exposure to influenza A (H1 N1 ) patients, but they occurred at the same time in the same ward. Fever was the initial symptom. The body temperatures of 5 cases were over 39.0℃ with the highest of 40.3℃, which lasted from 3 to 11 days with an average of 7 days. Influenza A (H1N1) associated coronavirus specific RNA fragment were positive by real-time RT-PCR in 6 cases.IgM antibodies to Mycoplasma pneumoniae and tuberculosis, GM test as well as blood culture for bacteria were negative. Chest CT of 6 cases showed macular opacities with cord-like shadows and higher density of the lesions in multi lung lobus. The lesions developed rapidly and were absorbed slowly in the lungs.Three cases had signs of fibrosis in the lungs. Five cases were successfully recovered and 1 case died of respiratory failure. Conclusion Compared with influenza A (H1N1) children alone, influenza A (H1N1) children with acute leukemia had severer symptoms and signs. The chest CT showed the characteristics of multi and larger lesions with rapid development.%目的 探讨急性白血病患儿并发重症甲型H1N1流感的临床和胸部CT表现特点.方法 分析6例急性白血病患儿经流行病学、临床、实验室和影像学检查确诊并发重症甲型H1N1流感的临床资料和胸部CT表现.结果 6例患儿入院前虽无明确的甲型H1N1流感密切接触史,但发生在同一时间段、同一病区住院期间,发热为首发症状,5例体温在39.0℃以上,最高40.3℃,持续时间3～11 d,平均7 d.实验室检查:6例甲型H1N1流感病毒RNA特异性片段real-time RT-PCR检测均阳性;肺炎支原体IgM、结核抗体、GM试验及血培养等均阴性.胸部CT表现:多肺叶多个斑片状阴影及实变高密度影,病灶进展快,肺部病灶吸收时间长,3例出现肺部纤维化改变.5例好转出院,1例死亡.结论 急性白血病患儿并发甲型H1N1流感与无基础疾病儿童相比,其临床症状和体征相对比较重,胸部CT表现以病灶进展快、胸部病变范围较大、数量多为其特征.
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