中国大陆首例人感染禽流感病毒(H5N1)的调查与确认  

The first confirmed human case of avian influenza A (H5N1) in mainland, China

作　　者：余宏杰[1] 陈裕旭[2] 舒跃龙[3] 李俊华[2] 高占成[4] 胡世雄[2] 董捷[3] 张红[2] 向妮娟[1] 张烨[3] 胡英惠[5] 徐翠玲[3] 高立冬[2] 王敏[3] 李中杰[1] 周蕾[1] 刘志涛[1] 李德新[3] 王茂武[1] 王子军[1] 王宇[1] 杨维中[1] 

机构地区：[1]中国疾病预防控制中心,北京100050 [2]湖南省疾病预防控制中心 [3]中国疾病预防控制中心病毒病预防控制所 [4]北京大学人民医院 [5]北京儿童医院

出　　处：《中华流行病学杂志》2006年第4期281-287,共7页Chinese Journal of Epidemiology

摘　　要：目的确认2005年10月湖南省湘潭县发生的一起家庭聚集性(姐弟二人)不明原因肺炎病例的病因。方法访谈病例发病前后的相关知情人,重现病家暴露环境及发病时间序列,查阅临床病志,对病例和病死禽的密切接触者进行医学观察。采集病例咽拭子,应用逆转录-聚合酶链反应 (RT-PCR)和实时荧光定量PCR法,检测A/H5N1亚型特异的核酸片段,接种SPF鸡胚进行病毒分离。应用马血球血凝抑制试验和微量中和试验检测患者急性期和恢复期血清抗A/H5特异性抗体滴度。结果姐(病例1)弟(病例2)二人分别在其家鸡开始死亡2天和4天后出现发热和肺炎症状,病例1死于急性呼吸窘迫综合征和多器官功能衰竭,病例2痊愈。病例1病后第8天的血清A/H5抗体阴性,病例2急性期和恢复期血清抗体滴度呈4倍以上升高。192名密切接触者中,仅1名(接诊过病例1的医生)出现上呼吸道症状,但血清标本经微量中和试验阴性。结论病例2为中国大陆第一例感染禽流感病毒(H5N1)的确诊病例,病例1为临床诊断病例。二者发病最可能是感染了相同家庭环境中病死禽传播的H5N1病毒,调查中未发现两病例之间有互相传播的证据。Objective To ascertain the causation of a family duster involving two undefined pneumonia cases, a 12-year-old girl and her brother, reported October, 2005 in Xiangtan county, Hunan province. Methods Information on epidemiology and clinical manifestation of the cases was collected from interviewing the keyman and referring to related medical records. The environment exposure of the cases to their households and the timeline of the illness were reproduced, using this information. Medical check-up was undergone among the close contacts of the eases and on sick/dead poultry. Throat swab of the cases were collected and tested by both RT-PCR and real-time PCR to detect viral nucleic acids of A/H5N1, and were then inoculated into special pathogen free （SPF） embryonated hens＇ eggs. Serum of the cases including acute and convalescent phases were also collected and tested by microneutralization and haemagglutination-inhibition （HI） assays to detect H5-specific antibodies. Results Both the girl and her brother developed fever 2 and 4 days after sudden deaths of chickens being raised in the same house. Both of them had developed pneumonia and the girl died from acute respiratory distress syndrome （ARDS） complicated with multi-organ failure. The boy survived and subsequently discharged from hospital. An eitgh day serum from the girl tested H5 antibody negative, while 4-fold and greater increased in antibody titers were detected in serum from the boy using microneutralization and HI assays in sequential acute and convalescent sera. Of 192 cases, only one doctor who cared for the girl during hospitalization had upper respiratory symptoms but tested negative for H5N1 by microneutralization assay. Conclusion The boy was the first confirmed human case of avian influenza A （H5N1） in the mainland of China and his sister was diagnosed clinically. The most probable explanation of these two cases was that the transmission of H5N1 virus from infected poultry within the same household environment. No evidence of human-

关 键 词：禽流感 H5N1 家庭聚集性 

分 类 号：R512.99[医药卫生—内科学]