湖南省高致病性人禽流行性感冒一例临床分析  

A clinical analysis of a human case infected by influenza A （H5N1） in Hunan Province

作　　者：符政远[1] 周建亮[1] 杨翃[1] 

机构地区：[1]湖南省怀化市第一人民医院感染病科,418000

出　　处：《中华传染病杂志》2009年第10期614-618,共5页Chinese Journal of Infectious Diseases

摘　　要：目的了解高致病性H5N1人禽流行性感冒（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2009年1月在湖南省怀化市第一人民医院收治的例高致病性H5N1人禽流感的临床表现、实验室检查、影像学改变和治疗等多方面的资料进行回顾总结。结果患者经RT—PCR、实时荧光定量PCR方法确诊为高致病性H5N1人禽流感病例。患者发病前有禽流感环境暴露史，以咳嗽、咳痰起病，继而出现高热、咯血，病情进行性加重，出现呼吸困难，伴外周血WBC和淋巴细胞明显降低，肝功能和心肌酶谱明显异常。发病第6天胸部影像学可见右肺实变，继而迅速扩展至双肺，出现急性呼吸窘迫综合征（ARDS）样肺部表现。经抗病毒、抗细菌、糖皮质激素、呼吸机支持和对症治疗未见好转，于发病后第12天死于多器官功能衰竭。结论高致病性H5N1人禽流感病变进展快，出现ARDS合并多器官功能损害时，预后不佳。Objective To describe the clinical, laboratory and radiological characteristics of a human case infected by influenza A （H5N1）, and to understand its management and prognosis. Methods The clinical data of the first human case infected by influenza A（H5N1） in Hunan Province were collected and analyzed retrospectively. Results The first case infected by influenza A（H5N1） in Hunan Province was confirmed by reverse transcription-polymerase chain reaction （RT-PCR） and fluorescent quantitative PCR. The patient had been exposed to the environment of bird flu before illness. The initial symptoms included cough and sputum with influenza-like symptoms, and after that high fever and hemoptysis appeared. The clinical situation of the patient deteriorated progressively with occurrence of dyspnea. Laboratory abnormalities included decrease of peripheral white blood cells and lymphocytes, dramatic increase of enzymes associated with hepatic and myocardial injury. Pulmonary consolidation on right were evident at day 6 after illness, and rapidly progressed to bilateral lungs with acute respiratory distress syndrome（ARDS）-like changes. The patient was treated with antiviral, antibacterial and corticosteroids, and invasive mechanical ventilation were also administered, but didn＇t show any improvement. The patient died of multiple organ failure （MOF） 12 days after the onset of illness. Conclusions The influenza A（H5N1） infected human cases progress rapidly. Once ARDS with multiple organ damage or failure developed, the prognosis will be poor.

关 键 词：流感病毒A型 H5N1亚型 禽流感 呼吸窘迫综合征 成人 多器官功能衰竭 预后 

分 类 号：R686[医药卫生—骨科学]