北京地区输入性黄热病急性病程及随访研究
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摘要
目的对2016年北京地坛医院收治的输入性黄热病急性期及半年、一年随访资料进行分析,提高对输入性黄热病疫情的认识及救治水平。方法收集5例患者流行病学史、病原学、临床资料等并进行描述性分析。结果 5例输入性黄热病病例,2例重型,3例轻型,其中死亡1例。重型患者表现为发热伴严重肝肾衰竭、凝血功能障碍等;轻型患者肝损伤、胰腺损伤、血小板降低。半年随访时轻型患者恢复正常,重型患者1年随访时基本恢复。结论黄热病以肝肾损伤为主,存在心脏、胰腺等多器官损伤,甚至危及生命,肝功恢复时间较长,轻型半年内恢复,重型需1年以上恢复,且需警惕发生脂肪肝。
Objective To analyze the data of imported yellow fever in acute phase as well as half a year and oneyear follow-up in Beijing Ditan Hospital in2016,so as to improve understanding of epidemic situation and treatment level of imported yellow fever.Methods Epidemiological history,etiology and clinical data of 5 patients were collected and analyzed.Results There are 5 cases of imported yellow fever,2 of which were severe disease,3 were mild type,1 patient died.Severe patients had fever complicated with severe liver and kidney failure,coagulation dysfunction and so on;and mild patients were with liver and pancreatic damage,and thrombocytopenia.Mild patients recovered after half a year follow-up,and severe patients recovered after one-year follow-up.Conclusion Yellow fever is mainly caused by liver and kidney damage,it can damage heart,pancreas and other organs,even endanger life,the recovery time of liver function is long,recovery time of mild disease is half a year,severe disease needs more than one year,and the occurrence of fatty liver should be vigilant.
Objective To analyze the data of imported yellow fever in acute phase as well as half a year and oneyear follow-up in Beijing Ditan Hospital in2016,so as to improve understanding of epidemic situation and treatment level of imported yellow fever.Methods Epidemiological history,etiology and clinical data of 5 patients were collected and analyzed.Results There are 5 cases of imported yellow fever,2 of which were severe disease,3 were mild type,1 patient died.Severe patients had fever complicated with severe liver and kidney failure,coagulation dysfunction and so on;and mild patients were with liver and pancreatic damage,and thrombocytopenia.Mild patients recovered after half a year follow-up,and severe patients recovered after one-year follow-up.Conclusion Yellow fever is mainly caused by liver and kidney damage,it can damage heart,pancreas and other organs,even endanger life,the recovery time of liver function is long,recovery time of mild disease is half a year,severe disease needs more than one year,and the occurrence of fatty liver should be vigilant.
引文
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[2]World Health Organization.Yellow fever-Angola[EB/OL].(2019-02-12)[2019-02-16].http://www.who.int/csr/don/12-february-2016-yellow-fever-angola/en.
[3]Ling Y,Chen J,Huang Q,et al.Yellow fever in a worker returning to China from Angola,March 2016[J].Emerg Infect Dis,2016,22(7):1317-1318.
[4]Song R,Guan S,Lee SS,et al.Late or lack of vaccination linked to importation of yellow fever from Angola to China[J].Emerg Infect Dis,2018,24(7):1383-1386.
[5]Chen Z,Liu L,Lv Y,et al.A fatal yellow fever virus infection in China:description and lessons[J].Emerg Microbes Infect,2016,5(7):e69.
[6]中华人民共和国国家卫生和计划生育委员会.黄热病诊疗方案(2016年版)[J].传染病信息,2016,29(3):125-128.
[7]Woodall JP,Yuill TM.Why is the yellow fever outbreak in Angola a‘threat to the entire world’?[J].Int J Infect Dis,2016,48:96-97.
[8]Ahmed QA,Memish ZA.Yellow fever from Angola and Congo:a storm gathers[J].Trop Doct,2017,47(2):92-96.
[9]王希,徐伟丽.1例黄热病疫苗引发的嗜内脏损害反应患者的护理[J].中华护理杂志,2005,40(11):846-847.
[10]王文政,陈志海.黄热病研究进展[J].国际病毒学杂志,2017,24(2):137-141.
[11]Denis B,Chirio D,Ponscarme D,et al.Hepatitis rebound after infection with yellow fever virus[J].Emerg Infect Dis,2019,25(6):1248-1249.
[12]施军平,范建高,武瑞,等.慢性乙型肝炎患者肝细胞脂肪变的发生率及其危险因素分析[J].中华肝脏病杂志,2008,16(7):519-523.
[13]刘景春,郭春涛.慢性丙型病毒性肝炎合并肝脂肪变的相关因素研究[J].海南医学,2015,26(7):967-970.
[14]Li M,Wang B,Li L,et al.Rift valley fever virus and yellow fever virus in urine:apotential source of infection[J].Virol Sin,2019,34(3):342-345.
[15]Stevanson LD.Pathological changes in the central nervous system in yellow fever[J].Arch Path,1939,27:24-54.
[16]Beck AS,Wood TG,Widen SG,et al.Analysis by deep sequencing of discontinued neurotropic yellow fever vaccine strains[J].Sci Rep,2018,8(1):13408.
[17]Furuta Y,Gowen BB,Takahashi K,et al.Favipiravir(T-705),a novel viral RNA polymerase inhihitor[J].Antiviral Res,2013,100(2):446-454.
[18]de Melo AB,da Silva Mda P,Magalhes MC,et al.Description of a prospective 17DD yellow fever vaccine cohort in Recife,Brazil[J].Am J Trop Med Hyg,2011,85(4):739-747.
[19]Wieten RW,Jonker EF,van Leeuwen EM,et al.A single 17d yellow fever vaccination provides lifelong immunity;characterization of yellow-fever-specific neutralizing antibody and T-cell responses after vaccination[J].PLoS One,2016,11(3):e0149871.
[20]Barrett AD,Teuwen DE.“Yellow fever vaccine-how does it work and why do rare cases of serious adverse events take place?”[J].Curr Opin Immunol,2009,21(3):308-313.
[21]国际在线.中国质检总局赴安哥拉防疫组为海外公民健康护航[EB/OL].(2016-04-06)[2019-02-06].http://news.cri.cn/201646/305bbfd9-d28b-ae81-7b5a-ccaea8b3a739.html.