江西省首例高致病性H_5N_1人禽流感临床特点分析  

Clinical characteristic analysis of the first human case infected by influenza A(H_5N_1) in Jiangxi Province

作　　者：张伟[1] 温乐英[2] 陆敏[3] 熊宇[1] 钱克俭[4] 邓爱花[5] 郭路生[6] 肖祖克[7] 赵新生[2] 段书敏[2] 谢志刚[3] 高子芬[3] 李敏[3] 邵宏权[3] 王国干[8] 刘大为[9] 高占成[10] 

机构地区：[1]江西省南昌大学附属第一医院呼吸科,330006 [2]中国疾病预防控制中心病毒病预防控制所 [3]北京大学医学部基础学院病理系 [4]江西省南昌大学附属第一医院ICU,330006 [5]江西省肺科医院内科 [6]江西省遂川县人民医院内科 [7]江西省人民医院呼吸科 [8]中国医学科学院中国协和医科大学阜外心血管病医院心内科 [9]中国医学科学院中国协和医科大学北京协和医院ICU [10]北京大学人民医院呼吸科

出　　处：《中华结核和呼吸杂志》2006年第5期300-306,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：卫生部卫生应急办公室项目支持

摘　　要：目的了解高致病性H5N1人禽流感病例的临床表现、实验室检查、影像学特征、治疗及其预后。方法对2005年12月在江西省遂川县人民医院收治的1例高致病性H5N1人禽流感的临床表现、实验室检查、心电图、影像学改变、病理变化和治疗等多方面的资料进行总结。结果患者经逆转录聚合酶链反应(RT PCR)、实时荧光定量PCR(real timePCR)方法和病毒分离确诊为高致病性H5N1人禽流感病例。患者发病前有禽流感环境暴露史,以发热、畏寒起病,伴流感样症状,继之出现咳嗽、咳脓痰和脓血痰,病情进行性加重,出现腹泻和呼吸困难,伴外周血白细胞和淋巴细胞明显降低、大量尿蛋白、肝功能和心肌酶谱明显异常及血清白蛋白明显降低。发病第6天后痰培养多次发现耐苯唑西林肺炎球菌,在病情明显加重后,痰培养出现其他细菌和真菌。发病初期(第5天)胸部影像学可见右肺中下高密度病灶,继之迅速发展至双肺,出现急性呼吸窘迫综合征(ARDS)样肺部表现。经抗病毒、抗细菌、抗真菌、糖皮质激素和对症治疗未见好转,于发病后第27天死于感染性休克和多器官功能衰竭。病理表现为双肺弥漫性肺泡损伤合并感染,继发弥漫性血管内凝血(DIC);淋巴组织中淋巴细胞明显减少,组织细胞增生;心肌水肿、空泡变性;肾小管广泛坏死。结论高致病性H5N1人禽流感患者病变进展为ARDS合并多器官功能损害时,预后不佳。Objective To describe the clinical,laboratory and radiological presentation of a human case infected by influenza A （ H5N1 ）, and to understand its management and prognosis. Methods The clinical and autopsy data of the first human case infected by influenza A（ H5N1 ） in Jiangxi Province were collected and analyzed. Results The first case infected by influenza A（ H5N1 ） in Jiangxi Province was confirmed by laboratory findings with reverse transcription-polymerase chain reaction （RT-PCR） and influenza A（ H5N1 ） isolation. The patient had been healthy in the past and exposed to the environment of bird flu before illness. The initial symptoms included high fever with influenza-like symptoms, and then cough and purulent sputum mixed with blood appeared. The clinical situation deteriorated progressively with occurrence of diarrhea and dyspnea. Laboratory abnormalities included decrease of peripheral white blood cells and lymphocytes, urine protein, dramatic increase of enzymes associated with hepatic injury and myocarditis and decrease of serum albumin. Six days later,penicillin-resistant streptococcuspneumoniae was isolated from multiple sputum cultures. With the deterioration of clinical situation, several other bacteria and fungi were found in sputum culture. Pulmonary infiltrates were evident in right middle and lower lobe at day 5 after illness, and rapidly progressed to involve bilateral lungs as acute respiratory distress syndrome （ARDS）-like changes. The patient was treated with antiviral, antibacterial, and antifungal reagents, and corticosteroids and invasive mechanical ventilation were also administered ,but without any improvement. The patient died 27 days after the onset of symptoms and an autopsy was performed. Pathologically, the lungs exhibited diffuse alveolar damage. The lymphocytes in the spleen, the lymph nodes and the tonsils were depleted prominently with histiocytic hyperplasia and hemophagocytic phenomena. Edema and degeneration of myocytes in the heart and extensive acut

关 键 词：高致病性H5N1人禽流感 呼吸窘迫综合征 急性 弥漫性肺泡损伤 多器官功能衰竭 

分 类 号：R512.99[医药卫生—内科学]