四川省首发六例人感染H7N9禽流感重症患者的临床特征分析  

Severely ill human infection with avian influenza A(H7N9) virus firstly identified in Sichuan province: six cases report and clinical analysis

作　　者：夏洪韬[1] 曹霖[1] 何正光[1] 陈亮[1] 敬毅[1] 龚宇[1] 何洋[2] 刘涛[3] 赵川[1] 李毅[1] 梁宗安[4] XIA Hongtao CAO Lin HE Zhengguang CHEN Liang JING Yi GONG Yu HE Yang LIU Tao ZHAO Chuan LI Yi LIANG Zongan(Suining Central Hospital, Suining, Sichuan 629000, P.R.China The First Suining People＇s Hospital, Suining, Sichuan 629000, P.R.China Suining Traditional Chinese Medicine Hospital, Suining, Sichuan, 629000, P.R.China Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China)

机构地区：[1]遂宁市中心医院,四川遂宁629000 [2]遂宁市第一人民医院,四川遂宁629000 [3]遂宁市中医院,四川遂宁629000 [4]四川大学华西医院呼吸与危重医学科,四川成都610041

出　　处：《中国呼吸与危重监护杂志》2017年第2期103-108,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的分析人感染H7N9禽流感重症患者的临床特征,以期总结出适合基层医院实施的早期诊断、早期治疗方案。方法搜集6例人感染H7N9禽流感重症患者发病初期的临床症状、实验室检验结果、影像学资料以及在各级医院的诊疗经过,找出其共有的临床特征。结果 6例患者均有禽类接触史,临床表现为发热、咳嗽、咳痰等症状;血常规中白细胞和(或)淋巴细胞计数显著降低,血小板计数降低,血生化中血磷、血钙均降低;胸部CT检查均提示以下肺为主、双肺受累、进展迅猛的渗出和实变病灶,以及不同程度的胸腔积液;初期的常规抗感染治疗均无效。结论人感染H7N9禽流感重症患者具有高热、咳嗽的症状,特征性的白细胞、淋巴细胞计数降低,迅猛进展的病情变化,典型的CT影像特征,以及禽类接触史。这些临床特征和流行病学史有助于早期诊断、早期治疗。Objective Since the first case of avian influenza A （H7N9） virus infection in humans identified in Suining, Sichuan province on January 25th, 2017, there were other five severely ill patients confirmed in the following 3 weeks. It is urgent to find out the common clinical characters of these patients, so that to make sure the optimal ways for early diagnosis and treatment for H7N9 virus infection in community hospitals or primary hospitals as soon as possible. Methods The early symptoms, the data of early laboratory findings, the early imaging study, the early process of diagnosis and treatment of these six patients were collected and analyzed. Results All six patients had high fever, dry cough, hypocalcemia, and hypophosphatemia, with advanced CT image lesions manifested as consolidation and ground- grass opacity in bilateral lower lung lobes. Some patients had typically leukopenia, lymphopenia, thrombocytopenia. And most of them had a history of direct exposure to live poultry before complaining of fluqike syndromes. However, the flu can not be effectively controlled by routine anti-infection. Conclusion The human infection with H7N9 virus can be early identified by combining the epidemiology of live poultry exposure, the symptoms of high fever, dry cough, dramatical leukopenia, lymphopenia, thrombocytopenia, the typical CT image, and the rapidly worsen clinical condition.

关 键 词：人感染H7N9禽流感 重症肺炎 早期诊断 

分 类 号：R511.7[医药卫生—内科学]