新型甲型H1N1流感监测体系的建立与应用分析  

Establish and application of influenza A (H1N1) pdm09 disease surveillance

作　　者：李铁钢[1] 李魁彪[1] 肖新才[1] 陈宗遒[1] 刘慧[1] 陆剑云[1] 狄飙[1] 

机构地区：[1]广州市疾病预防控制中心,广东广州510080

出　　处：《热带医学杂志》2015年第1期91-94,共4页Journal of Tropical Medicine

基　　金：广东省医学科研基金(A2011507)

摘　　要：目的了解甲型H1N1流感病毒病原学变迁与变异特征,分析重症病例危险因素,为科学防控提供依据。方法建立甲型H1N1流感监测体系,定期收集生物学标本实施甲型H1N1流感病毒核酸检测、病毒分离与测序分析;利用Logistics回归模型分析重症病例发生死亡的危险因素。结果 2009-2013年甲型H1N1流感病毒分离阳性率分别为13.83%（481/3 479）、4.46%（136/3 047）、9.13%（233/2 550）、0（0/2 643）和4.68%（159/3 400）。共完成18株毒株测序,2009-2010年的9株毒株位于第一主干枝,2011年的4株甲型H1N1流感病毒毒株聚集成第二主干枝,2013年的5株毒株中有4株位于第三主干枝。从2011年起,甲型H1N1流感毒株与疫苗株相距较远;共报告重症病例77例,其中40例（57.14%）有基础疾患,死亡16例。多因素Logistic分析显示慢性肺部疾病进入回归方程,OR=7.72（95%CI：1.97-30.23）。结论甲型H1N1流感监测系统在广州运行良好。甲型H1N1流感已经取代了A（H1N1）流感呈现季节性流行,慢性肺部基础疾患是甲型H1N1流感重症病例发生死亡的危险因素。2011年起,甲流疫苗与广州人群的流行毒株匹配较差,应持续开展甲流监测,密切关注毒株变化特征。Objective To understand virus changes and variability of influenza A（H1N1）pdm09（p H1N1）, analyze the risk factor associated with severe cases and provide the scientific basis for prevention and control of influenza outbreak.Methods A p H1N1 surveillance system was setup and biological specimens of influenza like cases were collected for p H1N1 virus nucleic acid detection, virus isolation and DNA sequencing. Logistic regression model was used to analyze the risk factors of death in severe cases. Results The positive rates of 2009 to 2013 years of H1N1 influenza virus were 13.83%（481 / 3 479）, 4.46%（136 / 3 047）, 9.13%（233 / 2 550）, 0（0 / 2 643） and 4.68%（159 / 3 400）, respectively. A total of 18 isolates were sequenced. Of which, 9 strains from 2009-2010 located in the first main branch, 4 strains from 2011 located in the second main branch, 4 strains from 2013 located in the third main branch. From 2011, the p H1N1 strains began to be far apart from vaccine strains. A total of 77 severe cases were reported; of which, 40 cases（57.14%） had underlying diseases,and 16 cases of death. Logistic multivariate analysis showed that chronic lung disease were entered into the regression equation, OR =7.72（95% CI：1.97 -30.23）. Conclusion p H1N1 surveillance system worked well in Guangzhou. Our study showed that p H1N1 has substituted for seasonal influenza A（H1N1） and became seasonal epidemic; chronic lung underlying diseases are risk factors for severe cases ended in deaths. Since 2011, the p H1N1 epidemic strains had matched poorly with vaccine strains in Guangzhou, and the monitoring of influenza like disease should be continued.

关 键 词：甲型H1N1流感 监测 病原学 序列分析 危险因素 

分 类 号：R373.13[医药卫生—病原生物学]