H7N9禽流感患者生化指标的变化及其临床意义  

Changes and clinical significance of biochemistry markers in patients with avian influenza A( H7N9) virus infection

作　　者：陈智瑾[1] 李海聪[1] 方欢英[1] 周毅[1] 张军[1] 

机构地区：[1]上海市公共卫生临床中心医学检验科,上海201508

出　　处：《检验医学》2013年第9期749-754,共6页Laboratory Medicine

摘　　要：目的探讨H7N9禽流感(2013年)患者治疗前、后生化指标的变化情况及其临床意义。方法分别检测17例H7N9禽流感患者[12例治愈(H7N9治愈组)、5例死亡(H7N9死亡组)]的心肌指标[包括心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)和氨基末端B型钠尿肽原(NT-proBNP)]、肝功能指标[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰基转移酶(GGT)、碱性磷酸酶(ALP)、总蛋白(TP)和总胆汁酸(TBA)]、肾功能指标[肌酐(Cr)和尿素氮(BUN)]共12项生化指标的水平,对比患者治疗前、后各项指标的变化。分别以50例甲型H1N1流感患者(2009年)作为疾病对照组(H1N1组)、12名健康体检者作为正常对照组,并进行比较。结果与正常对照组比较,H7N9治愈组和H1N1组治疗前均表现为CKMB、MYO和NT-proBNP水平升高(P<0.05),cTnT正常(P>0.05);AST、ALT和GGT水平升高(P<0.05),ALP和TP水平下降(P<0.05);Cr和BUN均无异常(P>0.05)。与H1N1组比较,H7N9治愈组除血清ALT、ALP、GGT和TP升高/降低程度不一致外,其余指标差异均无统计学意义(P均>0.05)。H7N9死亡组CK-MB和NTproBNP水平高于H7N9治愈组,且出现TBA和Cr升高(P<0.05)。与治疗前比较,H7N9治愈组治疗后CKMB、MYO、NT-proBNP、AST和TBA水平降低,ALP、TP水平升高(P<0.05)。与正常对照组比较,H7N9治愈组治疗后除AST、ALT和GGT水平仍有差异外,其余指标差异均无统计学意义(P>0.05);而H7N9死亡组治疗后除TP以外其余指标均有差异(P<0.05)。结论 H7N9禽流感患者生化指标的检测对于该疾病的辅助诊断、病情判断及预后提示具有一定的意义;但其变化与2009年甲型H1N1流感类似。Objective To investigate the changes and clinical significance of biochemistry markers in patients with avian influenza A （H7N9） virus infection （2013） before and after treatment. Methods A total of 12 biochemistry markers, including cardiac markers [ cardiac troponin T （cTnT）, creatine kinase isoenzyme （CK-MB）, myoglobin （MYO） and B-type natriuretic peptide （NT-proBNP） ], liver function markers [ aspartate aminotransferase （ AST）, alanine aminotransferase （ ALT）, gamma-glutamyl transpeptidase （ GGT ）, alkaline phosphatase （ ALP ）, total protein （ TP ） and total bile acid（TBA） ] and kidney function markers [ creatinine（Cr） and urea nitrogen（BUN） ] were determined in 12 cured patients （H7N9 cure group）,5 dead patients （H7N9 death group） with avian iniluenza A （H7N9） virus infection. A total of 50 patients with avian influenza A （H1N1） virus infection （2009） （H1N1 group） and 12 healthy subjects （control group） were enrolled, and the results were analyzed and compared. Results The levels of CK-MB, MYO and NT-proBNP increased in H7N9 cure group and HIN1 group compared with those in control group before the treatment （ P 〈 0.05 ）, however, the level of cTnT was normal （ P 〉 0.05 ）. The levels of AST, ALT and GGT increased （ P 〈 0.05）, while those of ALP and TP decreased （P 〈 0.05）. The levels of Cr and BUN were normal （ P 〉 0.05 ）. Compared with H1 N1 group, the increase and decrease degrees for the levels of ALT, ALP, GGT and TP were different, and there was no statistical significance for the other markers （P 〉 0.05 ）. The levels of CK-MB and NT-proBNP in H7N9 death group were higher than those in H7N9 cure group, and the levels of TBA and Cr increased （P 〈 0.05 ）. The levels of CK-MB, MYO, NT-proBNP, AST and TBA decreased after the treatment compared with those before thetreatment, and the levels of ALP and TP increased （P 〈 0.05 ）. Compared with the control group, except AST, ALT and

关 键 词：H7N9型禽流感病毒 感染 生化指标 心肌标志物 

分 类 号：R373.1[医药卫生—病原生物学]