人感染H7N9禽流感出院患者的随访研究  

Follow-up study of discharged patients infected with novel recombinant avian-origin influenza

作　　者：朱莹[1] 张志勇[1] 施裕新[1] 王青乐[1] 马倩[1] 

机构地区：[1]复旦大学附属公共卫生临床中心放射科,上海201508

出　　处：《中华放射学杂志》2013年第9期786-789,共4页Chinese Journal of Radiology

摘　　要：目的分析人感染H7N9禽流感出院患者胸部CT表现和实验室结果，为H7N9感染影像学动态变化提供依据。方法收集上海市公共卫生临床中心收治的4例H7N9感染出院患者的临床及影像资料，分析影像学动态变化及与实验室结果的相关性。结果4例患者从入院至出院行2～5次胸部CT检查，初次影像表现：3例以左肺下叶分布为主，1例主要分布于右肺下叶，病灶以磨玻璃密度（GGO）影为主；肺内病灶的影像表现呈多变性，吸收、进展交替出现，以GGO为主的病变均于治疗后平均3d左右可见明显吸收，3例以实变为主的病灶治疗后呈进展趋势，1例治疗后实变灶进展后逐渐吸收；1例出院后7d复查，肺内病灶明显吸收。肺内病灶进展趋势多对应血淋巴细胞绝对数和白细胞计数增加趋势。3例CD3、CD8、CD4、CD45绝对值同步减低，同时CD4／CD8比值均正常。结论（1）H7N9感染引起的肺炎较为严重，病灶的影像表现多变，病灶总面积及其性质对决定预后有重要意义。（2）H7N9病毒感染可导致机体免疫功能抑制，血C反应蛋白的降低可预测病情的好转。Objective To analyze the laboratory results and chest CT appearances of novel recombinant avian-origin influenza A （H7N9） in discharged patients for understanding the imaging changes. Methods The clinical and imaging data of 4 patients with novel recombinant avian-origin influenza A （H7N9） were collected. The imaging changes and laboratory results were analyzed. Results All patients underwent chest CT examination 2 to 5 times from admission to discharge. The lesions primarily presented as ground-glass opacity （GGO） and mainly located in the inferior lobe of the left lung in 3 cases, in the inferior lobe of the right lung in 1 case, alternating between absorption and progress. GGO was absorbed obviously in about 3 days after treatment and consolidation was progressed after treatment. Consolidation absorption was observed with continue treatment in 1 case. The pulmonary lesions were absorbed obviously in 1 case 7 days after discharge. Synchronous reduction of the absolute values of CD3, CD8, CD4, CD45 were observed in 3 cases and the ratio of CD4/CD8 was normal. Conclusions （ 1 ） The areas of pulmonary involvement are large and variable in H7N9. The lesion area and imaging patterns are important for disease prognosis. （2） H7N9 virus infection may causes immunosuppression, decrease of CRP value can predict the improvement of the disease.

关 键 词：禽流感 肺炎 体层摄影术 X线计算机 放射摄影术 

分 类 号：R511.7[医药卫生—内科学]