江苏省首例人感染高致病性禽流感病例的确认及其病原的基因特征研究  

DIAGNOSIS AND MOLECULAR CHARACTERISTICS STUDY ON THE FIRST CASE OF HIGHLY PATHOGENIC AVIAN INFLUENZA VIRUS (H5N1) IN JIANGSU

作　　者：潘浩[1,2] 祖荣强[1] 陆小军[3] 朱凤才[1] 李亮[1] 史智阳[1] 鲍昌俊[1] 李显[1] 邓斐[1] 汪华[1] 

机构地区：[1]江苏省疾病预防控制中心,南京210009 [2]上海市疾病预防控制中心 [3]南京市疾病预防控制中心

出　　处：《现代预防医学》2010年第7期1205-1210,共6页Modern Preventive Medicine

摘　　要：[目的]确认2007年12月江苏省首例人感染高致病性禽流感病例,探究病例的临床变化规律及其病原的基因特征。[方法]通过知情人访谈和查阅病志方式开展流行病学调查,病例密切接触者进行医学观察。采集病例气管吸取物呼吸道标本,运用荧光定量RT-PCR法进行H5N1基因检测,并开展病毒分离,分析血凝素(HA)基因特征。[结果]病例无明确禽类接触和暴露史,69名密切接触者患者父亲发病。病例病后d5后即出现"白肺",病后d8死亡,白细胞和血小板进行性下降。下呼吸道标本H5N1病毒HA和NA基因均为阳性,病原培养物经鉴定为H5亚型禽流感病毒。该分离株HA基因同源性分析显示接近我国浙江、安徽等地分离株(99.0%,98.9%)。系统发生树分析为CladeⅡ系的2.3.4基因亚群,病毒HA1和HA2连接肽及细胞受体结合位点分析表明该分离株仍为禽源特性。[结论]该病例为江苏省首例人感染高致病性禽流感(H5N1)病例,无明确的禽类暴露史。分离株为2.3.4基因亚群,基因特征仍为禽源特性。[Objectivel To confirm the first H5N1 avian influenza infected case in November 2007 in Nanjing, and de- scribe clinical manifestations of the case and analyze the genetic characteristics of virus isolated from the case. [Methods] In- formation on epidemiology and clinical manifestations of the case were collected by key intbnnant interview and referring to re- lated medical records. The poultry exposure of the case and the timeline of the illness were reproduced. The tracheal aspirate from the case was collected and tested with real time RT-PCR to detect viral nucleic acid of A/H5N1, and was inoculated to isolate virus. The hemagglutinin （HA） genes of isolated virus was sequenced and analyzed. [ Results] The epidemiologic in- vestigation results indicated that the case didn＇t expose to and contact with sick and dead poult~）~. White X-ray examination found three days after the case got pneumonia. The white blood cells and blood platelets were found to progressively decline. The tracheal aspirate was found positive with H5N1 genes test and the isolated virus was identified as H5 serotype. By comparing with other HSN1 strains, the HA gene segment homogeneity of isolated strain was 99.0% with Zhejiang, and 98.9% with Anhui strains, 98.7% with H5Nlstrains from avian in Jiangsu, respectively. The analysis of HA gene sequence of isolated strain showed that it belonged to 2.3.4 subgroup of H5N1 Clade Ⅱ genotype and the receptor specificity and the connecting peptide between HAl and HA2 was still avian influenza origin. [Conclusion] The patient is confirmed to be infected by H5NI virus and the first case of Jiangsu. Exposure to poultru of the case isn＇t found. The virus isolated from case is 2.3.4 subgroup of H5N1 and is avian origin.

关 键 词：高致病性禽流感 H5N1 基因特征 

分 类 号：R511[医药卫生—内科学]