9例重症人感染H7N9禽流感的临床特征分析
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摘要
目的分析重症人感染H7N9禽流感病例的临床特征,为临床诊断和治疗提供依据。方法回顾性分析2017年我院收治的9例人感染H7N9禽流感重症病例的流行病学特征、临床症状、实验室检查及治疗转归。结果 9例重症患者均以发热、咳嗽、气促等症状起病,部分患者呈持续性高热,热程第3-10天进展为急性呼吸窘迫综合征(ARDS)。胸部CT提示双肺感染病灶广泛,以实变为主,进展迅速;实验室检查显示:白细胞计数正常或者降低,可伴血小板下降,乳酸脱氢酶、超敏C反应蛋白升高,CD_4~+T淋巴细胞计数下降,部分危重病例降钙素原、1-3-β葡聚糖水平升高。流行病学调查显示:9例患者均有禽类接触史。最终治愈6例,死亡3例。结论人感染H7N9禽流感肺部病变进展迅速,死亡率高,高龄、高血压、糖尿病、慢阻肺等基础疾病是死亡高危因素,因此早发现、早诊断、早治疗是关键。在冬春季节应高度重视不明原因肺炎,特别是合并心血管、肺部基础疾病患者更需加强重视。
Objective To analyze the clinical feature of severe human infection with H7 N9 avian influenza and further help with the clinical diagnosis and treatment. Methods The clinical features and treatment outcomes of9 cases of severe human infection with H7 N9 avian influenza were retrospectively analyzed. Results The 9 cases of human infection all began with the same symptoms like fever,coughing and tachypnea,and some of them suffered ongoing increasing high fever. The high fever then deteriorated into acute respiratory distress syndrome( ARDS) during the 3 rd day to the 10 th day. According to chest CT,the focal infection of both lungs was wide and progressing rapidly,characterized by consolidation. The laboratory test showed that the number of white blood cells was at the normal level or decreased,and the number of platelets decreases,lactic dehydrogenises and High-sensitivity C-reactive protein increased,CD_4~+ T lymphocytes decreased,and for some severe cases,the number of calcitoninincreases andthe results of fungal G test also indicated an increase. And the epidemiological survey showed that all of the 9 human cases of infection had contacts with the poultry,and 6 of them were fully cured while 3 of them were dead finally. Conclusion The lung lesion of human infection with H7 N9 progresses rapidly and the mortality is high. The high mortality is mainly caused by advanced age,high blood pressure,diabetes and chronic obstructive pulmonary disease( COPD). Therefore,it is important to notice the disease at the early stage,and diagnose and treat it as soon as possible. And we should also pay high attention the pneumonia with unknown reasons in spring and autumn,especially those who have had combined cardiovascular disease andpulmonary basic diseases.
Objective To analyze the clinical feature of severe human infection with H7 N9 avian influenza and further help with the clinical diagnosis and treatment. Methods The clinical features and treatment outcomes of9 cases of severe human infection with H7 N9 avian influenza were retrospectively analyzed. Results The 9 cases of human infection all began with the same symptoms like fever,coughing and tachypnea,and some of them suffered ongoing increasing high fever. The high fever then deteriorated into acute respiratory distress syndrome( ARDS) during the 3 rd day to the 10 th day. According to chest CT,the focal infection of both lungs was wide and progressing rapidly,characterized by consolidation. The laboratory test showed that the number of white blood cells was at the normal level or decreased,and the number of platelets decreases,lactic dehydrogenises and High-sensitivity C-reactive protein increased,CD_4~+ T lymphocytes decreased,and for some severe cases,the number of calcitoninincreases andthe results of fungal G test also indicated an increase. And the epidemiological survey showed that all of the 9 human cases of infection had contacts with the poultry,and 6 of them were fully cured while 3 of them were dead finally. Conclusion The lung lesion of human infection with H7 N9 progresses rapidly and the mortality is high. The high mortality is mainly caused by advanced age,high blood pressure,diabetes and chronic obstructive pulmonary disease( COPD). Therefore,it is important to notice the disease at the early stage,and diagnose and treat it as soon as possible. And we should also pay high attention the pneumonia with unknown reasons in spring and autumn,especially those who have had combined cardiovascular disease andpulmonary basic diseases.
引文
[1]中华人民共和国国家卫生和计划生育委员会.上海、安徽发生3例人感染H7N9禽流感确诊病例[EB/OL].(2013-03-31)[2014-06-10].http://www.moh.gov.cn/mohwsyjbgs/s3578/201303/44f25bd6bed14cf082512d8b6258fb3d.shtml.
[2]CHEN H,YUAN H,GAO R,et al.Clinical and epidemiological characteristics of a fatal case of avian influenza A H10N8 virus infection:a descriptive study[J].Lancet,2014,383(9918):714-721.
[3]国家卫生和计划生育委员会.人感染H7N9禽流感诊疗方案(2017年第1版)[J].传染病信息,2017,30(1):后插1-后插3.
[4]夏洪韬,曹霖,何正光,等.四川省首发六例人感染H7N9禽流感重症患者的临床特征分析[J].中国呼吸与危重监护杂志,2017,16(2):103-108.
[5]CAO B,LI X W,SHU Y L,et al.Clinical and epidemiologic characteristics of 3 early cases of influenza A pandemic(H1N1)2009virus infection,People's Republic of China,2009[J].Emerg Infect Dis,2009,15(9):1418-1422.
[6]闫铁成,肖丹,王波,等.中国大陆130例人感染H7N9禽流感病例流行病学特征分析[J].中华疾病控制杂志,2013,17(8):651-654.
[7]GAO R,CAO B,HU Y,et al.Human infection with a novel avianorigin influenza A(H7N9)virus[J].N Engl J Med,2013,368(20):1888-1897.
[8]毛会军,陈戴红,张敏,等.H7N9禽流感患者外周血T淋巴细胞亚群的分析及意义[J].检验医学,2013,28(9):758-761.
[9]吕星,王晓辉,吴春利,等.H5N1亚型禽流感病毒诱导的机体免疫损伤分析[J].中国人兽共患病学报,2013,29(7):697-699.
[10]陈颖,王军,温华,等.重症甲型H1N1流感患者外周血T淋巴细胞亚群变化的临床意义探讨[J].中国医科大学学报,2011,40(2):140-143.
[11]DAI J,ZHOU X,DONG D,et al.Human infection with a novel avian-origin influenza A(H7N9)virus:serial chest radiographic and CT findings[J].Chin Med J(Engl),2014,127(12):2206-2211.
[12]国家卫生计生委办公厅.国家卫生计生委办公厅关于做好人感染H7N9禽流感医疗救治工作的通知:国卫发明电[2017]3号[A/OL].(2017-01-25)[2017-10-20].http://www.nhfpc.gov.cn/yzygj/s3593g/201701/2dbdbc6e82dd4fdfa57508499f61cdfc.shtml.
[13]季晶俊,陈晓宏,陈红,等.无创通气辅助治疗重症肺炎合并ARDS1例[J].中国社区医师,2014,30(19):134-135.
[2]CHEN H,YUAN H,GAO R,et al.Clinical and epidemiological characteristics of a fatal case of avian influenza A H10N8 virus infection:a descriptive study[J].Lancet,2014,383(9918):714-721.
[3]国家卫生和计划生育委员会.人感染H7N9禽流感诊疗方案(2017年第1版)[J].传染病信息,2017,30(1):后插1-后插3.
[4]夏洪韬,曹霖,何正光,等.四川省首发六例人感染H7N9禽流感重症患者的临床特征分析[J].中国呼吸与危重监护杂志,2017,16(2):103-108.
[5]CAO B,LI X W,SHU Y L,et al.Clinical and epidemiologic characteristics of 3 early cases of influenza A pandemic(H1N1)2009virus infection,People's Republic of China,2009[J].Emerg Infect Dis,2009,15(9):1418-1422.
[6]闫铁成,肖丹,王波,等.中国大陆130例人感染H7N9禽流感病例流行病学特征分析[J].中华疾病控制杂志,2013,17(8):651-654.
[7]GAO R,CAO B,HU Y,et al.Human infection with a novel avianorigin influenza A(H7N9)virus[J].N Engl J Med,2013,368(20):1888-1897.
[8]毛会军,陈戴红,张敏,等.H7N9禽流感患者外周血T淋巴细胞亚群的分析及意义[J].检验医学,2013,28(9):758-761.
[9]吕星,王晓辉,吴春利,等.H5N1亚型禽流感病毒诱导的机体免疫损伤分析[J].中国人兽共患病学报,2013,29(7):697-699.
[10]陈颖,王军,温华,等.重症甲型H1N1流感患者外周血T淋巴细胞亚群变化的临床意义探讨[J].中国医科大学学报,2011,40(2):140-143.
[11]DAI J,ZHOU X,DONG D,et al.Human infection with a novel avian-origin influenza A(H7N9)virus:serial chest radiographic and CT findings[J].Chin Med J(Engl),2014,127(12):2206-2211.
[12]国家卫生计生委办公厅.国家卫生计生委办公厅关于做好人感染H7N9禽流感医疗救治工作的通知:国卫发明电[2017]3号[A/OL].(2017-01-25)[2017-10-20].http://www.nhfpc.gov.cn/yzygj/s3593g/201701/2dbdbc6e82dd4fdfa57508499f61cdfc.shtml.
[13]季晶俊,陈晓宏,陈红,等.无创通气辅助治疗重症肺炎合并ARDS1例[J].中国社区医师,2014,30(19):134-135.