人感染高致病性H_5N_1亚型禽流感一例报告并文献复习  

A retrospective study of one case of human infection by the highly pathogenic avian influenza A(H_5N_1)

作　　者：周超[1] 方平[1] 刘又宁[2] 胡斌[1] 丁红梅[1] 徐晓玲[3] 吴昊[1] 王瑾[1] 林琳[1] 潘华[4] 吴同生[5] 宋有良[5] 

机构地区：[1]安徽省铜陵市人民医院呼吸科,244000 [2]解放军总医院呼吸科 [3]安徽省立医院呼吸科 [4]安徽省铜陵市人民医院神经内科,244000 [5]安徽省铜陵市人民医院感染内科,244000

出　　处：《中华结核和呼吸杂志》2006年第1期9-13,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨人感染高致病性H5N1亚型禽流感的临床特征及防治手段。方法2005年11月,救治1例确诊为感染高致病性H5N1亚型禽流感的青年女性患者,分析其临床表现、影像学及流行病学特点。结果患者发病前与病死家禽有密切接触史,从发病至死亡约10 d。在呼吸困难发生前,发热持续了5 d,以急性社区获得性肺炎及急性呼吸窘迫综合征(ARDS)为主要特征入院,X线胸片示双肺大片实变影并进行性进展,入院至死亡不足3 d。中国疾病预防控制中心应用逆转录-聚合酶链反应(RT-PCR)、实时聚合酶链反应(real-tim e PCR)技术检测患者下呼吸道吸出物标本,发现禽流感病毒血凝素(HA)5型特异性基因片段呈阳性;尸检肉眼所见主要有支气管充血、双肺实变,多浆膜腔积液;弥漫性血管内凝血(D IC)及多脏器功能衰竭(MOF)。结论人感染高致病性H5N1亚型禽流感是一种致命的传染性疾病。提高认识,重视流行病学调查并及早干预是降低病死率的主要手段。Objective To describe the clinical features of the infection caused by the highly pathogenic avian influenza A（H5N1 ）. Methods A previously healthy 24 year old woman presented to our hospital on November 7,2005. She was confirmed to be an H5N1 infected case after death. The clinical, radiological and epldemiological data were analyzed. Results The patient had a history of direct contact with diseased and dead poultry（ chicken and duck）. The disease course was 10 days from onset of illness to death,and fever preceded dyspnea by 5 days. On admission, the striking characteristics were acute community-acquired pneumonia （CAP） and acute respiratory distress syndrome （ARDS）, and the major radiographic abnormalities included extensive infiltration bilaterally, focal consolidation and air bronchograms. The radiographic and clinical deterioration was rapid, and the patient died in less than 3 days after hospitalization. The diagnosis of influenza A（ H5N1 ） was confirmed by means of reverse transcriptasepolymerase chain reaction （RT-PCR） and real-time PCR on specimens of the lower respiratory tract, performed by Chinese Center for Disease Control. The postmortem examination showed bronchial hyperemia, extensive consolidation, serous cavity effusions, disseminated intravascular coagulation （ DIC ） and multiple organ failure（MOF）. Conclusions Human infection by the highly pathogenic avian influenza A（ H5N1 ） is a fatal communicable disease. Information of avian influenza A （ H5N1 ） virus, more attention to the epidemiologic data, and early intervention are critical in reducing the mortality.

关 键 词：流感病毒A型 鸟 血凝素类 流行病学 

分 类 号：R512.99[医药卫生—内科学]