泉州地区2014～2017年H7N9禽流感病毒感染患者的临床和病毒特点分析
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摘要
本研究对福建省泉州地区2014~2017年12例H7N9禽流感病毒感染患者的临床特点和病毒基因特点进行了分析。结果显示,泉州市实验室确诊H7N9禽流感病毒感染患者的总体病死率(2/12,17%)低于全国平均水平,其流行病学特征与临床特点(C反应蛋白和低密度脂蛋白升高以及淋巴细胞减少症较常见)与中国其他地区报道的人感染H7N9疫情中感染患者的结果一致;不同的是,谷草转氨酶、谷丙转氨酶、肌酸激酶升高的患者以及出现白细胞减少症的患者比例较低。所获得的三个患者的HA和NA基因序列分析显示,泉州地区患者感染的H7N9禽流感病毒都属于长江三角洲谱系,且亲缘关系近;3株病毒HA蛋白的裂解位点均为PKGR/G,没有出现高致病性突变,NA蛋白292位氨基酸也没有出现奥司他韦(达菲)耐药突变,但PB2蛋白中都出现了与毒力相关的E627K突变。泉州地区H7N9禽流感病毒患者的临床特点和病毒基因特征可为人感染H7N9病毒的病原学监测及疫情的科学防控和风险评估提供参考依据。
We investigated the clinical and viral characteristics of 12patients infected with avian influenza A(H7N9)virus in Quanzhou,China,during 2014~2017.The fatality rate(2/12,17%)of patients infected with H7N9virus in Quanzhou was lower than that of China.Nevertheless,the epidemiologic and clinical characteristics(increased levels of C-reactive protein,lactate dehydrogenase and lymphopenia were common features)were consistent with the first four waves of human H7N9-virus infectionsin China.The incidence rate of increased levels of aspartate aminotransferase,alanine aminotransferase,creatinine kinase and leukopenia was lower for Quanzhou patients.Sequence analyses of the HA and NA genes of H7N9viruses from three patients in Quanzhou showed that H7N9 belonged to Yangtze River Delta lineage with high homology.Meanwhile,all the three H7N9viruseswere low pathogenic without neuraminidase inhibitor(NAI)resistance(R292Kin NA)mutation,while they all possessed the E627K mutation associated with virulencein the PB2proteins.In summary,the clinical and viral characteristics of H7N9 avian influenza virus in Quanzhou during 2014~2017may be of value for the etiological monitoring of H7N9virus as well as the scientific prevention and risk assessment of the outbreak.
We investigated the clinical and viral characteristics of 12patients infected with avian influenza A(H7N9)virus in Quanzhou,China,during 2014~2017.The fatality rate(2/12,17%)of patients infected with H7N9virus in Quanzhou was lower than that of China.Nevertheless,the epidemiologic and clinical characteristics(increased levels of C-reactive protein,lactate dehydrogenase and lymphopenia were common features)were consistent with the first four waves of human H7N9-virus infectionsin China.The incidence rate of increased levels of aspartate aminotransferase,alanine aminotransferase,creatinine kinase and leukopenia was lower for Quanzhou patients.Sequence analyses of the HA and NA genes of H7N9viruses from three patients in Quanzhou showed that H7N9 belonged to Yangtze River Delta lineage with high homology.Meanwhile,all the three H7N9viruseswere low pathogenic without neuraminidase inhibitor(NAI)resistance(R292Kin NA)mutation,while they all possessed the E627K mutation associated with virulencein the PB2proteins.In summary,the clinical and viral characteristics of H7N9 avian influenza virus in Quanzhou during 2014~2017may be of value for the etiological monitoring of H7N9virus as well as the scientific prevention and risk assessment of the outbreak.
引文
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[3]Wang D,Yang L,Zhu W,Zhang Y,Zou S,Bo H,Gao R,Dong J,Huang W,Guo J,Li Z,Zhao X,Li X,Xin L,Zhou J,Chen T,Dong L,Wei H,Li X,Liu L,Tang J,Lan Y,Yang J,Shu Y.Twooutbreak sources of influenza A(H7N9)viruses have been established in China[J].J Virol,2016,90:5561-5573.
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[5]Yang L,Zhu W,Li X,Chen M,Wu J,Yu P,Qi S,Huang Y,Shi W,Dong J,Zhao X,Huang W,Li Z,Zeng X,Bo H,Chen T,Chen W,Liu J,Zhang Y,Liang Z,Shi W,Shu Y,Wang D.Genesis andspread of newly emerged highly pathogenic H7N9avian viruses in mainland China[J].J Virol,2017,91.pii:e01277-17.
[6]Kile J C,Ren R,Liu L,Greene C M,Roguski K,Iuliano A D,Jang Y,Jones J,Thor S,Song Y,Zhou S,Trock S C,Dugan V,Wentworth D E,Levine M Z,Uyeki T M,Katz J M,Jernigan D B,Olsen S J,Fry AM,Azziz-Baumgartner E,Davis C T.Update:Increase in human Infections with novel Asian lineage avian Influenza A(H7N9)viruses during the Fifth Epidemic-China,October 1,2016-August 7,2017[J].MMWR Morb Mortal Wkly Rep,2017,66:928-932.
[7]Wang C,Yu H,Horby P W,Cao B,Wu P,Yang S,Gao H,Li H,Tsang T K,Liao Q,Gao Z,Ip D K,Jia H,Jiang H,Liu B,Ni M Y,Dai X,Liu F,Van Kinh N,Liem N T,Hien T T,Li Y,Yang J,Wu J T,Zheng Y,Leung G M,Farrar J J,Cowling B J,Uyeki T M,Li L.Comparison of patients hospitalized with influenza A subtypes H7N9,H5N1,and 2009pandemic H1N1[J].Clin Infect Dis,2017,58:1095-1103.
[8]Wu Y,Bi Y,Vavricka C J,Sun X,Zhang Y,Gao F,Zhao M,Xiao H,Qin C,He J,Liu W,Yan J,Qi J,Gao G F.Characterization of two distinct neuraminidases from avian-origin human-infecting H7N9influenza viruses[J].Cell Res,2013,23:1347-1355.