17例病毒性肺炎老年患者的临床特点及甲型H1N1流感病毒分子特征  

Clinical features and molecular characteristics of influenza A (H1N1) viral pneumonia in 17 elderly patients

作　　者：葛以跃[1] 谭焰[2] 陈晨[2] 吴涛[1] 朱小娟[1] 赵康辰[1] 王丽[2] 谷伟[2] 崔仑标[1] Ge Yiyue;Tan Yan;Chen Chen;Wu Tao;Zhu Xiaojuan;Zhao Kangchen;Wang Li;Gu Wei;Cui Lunbiao(Key Laboratories of Enteric Pathogenic Microbiology of Ministry of Health,Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009,China;Department of Respiratory Diseases,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]卫生部肠道病原微生物重点实验室江苏省疾病预防控制中心,南京210009 [2]南京医科大学附属南京医院呼吸科,210006

出　　处：《中华实验和临床病毒学杂志》2018年第6期576-581,共6页Chinese Journal of Experimental and Clinical Virology

基　　金：国家自然科学基金(81501785);国家科技重大专项(2017ZX10103008);江苏省科教强卫重点学科(ZDXKA2016008).

摘　　要：目的对17例老年甲型H1N1流感病毒性肺炎患者的临床和病原学检测结果进行分析,了解老年甲型H1N1流感病毒性肺炎的临床特点及病毒分子特征。方法收集2018年1~3月期间在南京市第一医院呼吸科住院的老年肺炎患者作为研究对象,通过呼吸道病毒核酸检查进行病例确诊。采集并分析病例的临床资料。扩增流感病毒全基因组后进行高通量测序,对测序结果进行生物信息学分析,研究病毒的抗原性、致病性和耐药性等生物学特征。结果入选的17例患者平均年龄为(73.8±10.8)岁,所有患者至少合并1种基础性疾病,7例存在合并感染。呼吸系统症状和发热是最为突出的临床表现,94.1%的患者伴有乳酸脱氢酶的增高,76.5%的患者影像学检查存在双肺病变,危重症患者双肺病变的比例高于重症患者。二代测序结果表明,病毒与疫苗株高度同源,HA基因同属于6B.1亚组,有3个抗原位点发生了变异(H138Y、S74R和S164T),1株病毒发生了NA的H275Y耐药变异。结论老年甲型H1N1流感病毒性肺炎患者多合并基础疾病,容易产生合并感染;应密切关注病毒的分子特征及关键氨基酸位点变异,为疫情防控和临床抗病毒治疗提供依据。Objective To analyze the clinical manifestations and results of etiological examinations of 17 elderly patients with influenza A (H1N1) viral pneumonia, and to understand the clinical features of pneumonia and molecular characteristics of influenza A (H1N1) virus infection in the elderly. Methods The elderly patients with pneumonia who were hospitalized in the Department of Respiratory Diseases of Nanjing First Hospital from January 2018 to March were enrolled. The cases were confirmed by nucleic acid examination for influenza virus and the clinical data were collected. After the amplification of the whole genome of influenza virus, the high throughput sequencing and bioinformatics analysis were performed. Results The mean age of the 17 enrolled patients was 73.8±10.8. All of them had at least 1 underlying disease, and 7 cases had co-infection. Respiratory symptoms and fever were the most prominent clinical manifestations. Lesions in both lungs were found in 76.5% of the patients. The result of high throughput sequencing showed that all the viruses were highly homologous to the vaccine strain, and the HA gene belonged to the 6B.1 subgroup. Furthermore, three variations of antigenic locus (H138Y, S74R and S164T in HA) and a drug-resistant variation (H275Y in NA) were detected in the circulating strains. Conclusions Elderly patients with influenza A (H1N1) virus pneumonia often have underlying diseases and are prone to have co-infection. The molecular characteristics of the virus and the variation of key amino acid loci should be closely monitored in order to provide evidence for epidemic prevention and clinical antiviral treatment.

关 键 词：老年 甲型H1N1流感 肺炎 临床特点 分子特征 

分 类 号：R563.1[医药卫生—呼吸系统] R511.7[医药卫生—内科学]