成人H7N9禽流感首现患者6例临床分析  

Analysis of 6 adults with novel influenza A （H7N9） virus infection

作　　者：马瑨[1] 何泽宝[1] 柳春霞[1] 黄建芳[1] 黄海滨[1] 度尧[1] 谢德胜[1] 

机构地区：[1]复旦大学附属上海市第五人民医院感染科,200240

出　　处：《临床内科杂志》2013年第12期833-835,共3页Journal of Clinical Internal Medicine

摘　　要：目的 分析6例H7N9禽流感首现患者的临床和流行病学特点,并对治疗方法进行探讨.方法 对我院6例H7N9禽流感患者的临床表现、流行病学资料、实验室检查、影像学资料进行回顾性分析.结果 6例患者均在闵行江川地区发病,均有发热、咳嗽,大多有痰中带血和呼吸困难（5/6）,部分患者伴畏寒寒战（1/6）、恶心（2/6）、呕吐（2/6）.血常规正常或下降（5/6）,淋巴细胞有不同程度下降（5/6）,C反应蛋白、门冬氨酸氨基转移酶、肌酸激酶和乳酸脱氢酶均明显升高（6/6）,胸部CT检查显示双肺磨玻璃样及实变阴影,具有短期内病灶进展快的特点;6例患者中进展为急性呼吸窘迫综合征4例,并最终死亡,2例无急性呼吸窘迫综合征者存活.结论 人感染H7N9禽流感为新发传染性疾病,可导致严重的呼吸窘迫综合症,死亡率高.Objective To analyze the clinical features,epidemiologic information and outcome in the confirmed cases of human infection with novel influenza A （H7N9）. Methods The clinical features and epidemiologic findings in 6 confirmed cases of influenza A（H7N9） in the Fifth People~ Hospital of Shanghai, Fudan University. Clinical data on vital signs, physical findings, laboratory tests and chest radio- graphic findings were obtained by means of retrospective review of the hospital records. Epidemiologic data were collected through interviews of the patients and their relatives. Results All the patients emerged in Jiang chuan street, Min hang district. 6 cases had fever and cough（6/6） ,5 had blood-tinged sputum and shortness of breath（5/6）, 1 had chills （ 1/6）, 2 had nausea and vomiting （ 2/6 ）. The WBC counts were normal or slightly decreased（5/6）. The platelet counts were decreased（6/6）. Elevated levels of aspartate aminotransferase, creatine kinase and iactate dehydrogenase were observed in all the patients （6/6）. There were marked abnormalities on chest radiography,radiographic changes include bilateral lobular consolida- tions with air bronchograms and ground-glass opacity, and had dramatic worsening of findings. Four of the 6 cases developed acute respiratory distress syndrome （ARDS） complicated muhiple organ dysfunction syndrome（MODS） and died of progressive respiratory failure. Two of the 6 cases survived without ARDS. Conclusion Severe avian influenza A（H7N9） infections, characterized by high fever and severe respira- tory symptoms, may pose a serious human health risk. effects. More data from different regions and large samples are needed to illuminate the characteristics of patients with novel influenza A（H7N9） virus infec- tion.

关 键 词：流感病毒A型 H7N9亚型 呼吸窘迫综合征 

分 类 号：R511.7[医药卫生—内科学]