17例人感染H7N9禽流行性感冒重症患者免疫状态回顾性研究  

A retrospective study of the immune status of 17severe patients with avian influenza A H7N9virus infection

作　　者：黄煌[1] 李幼霞 蔡水江 邓西龙[1] HUANG Huang;LI You-xia;CAI Shui-jiang;DENG Xi-long(Department of Critical Care Medicine,The Eighth People′s Hospital of Guangzhou city,Guangzhou,Guangdong 510060,China)

机构地区：[1]广州市第八人民医院重症医学科,广东广州510060

出　　处：《中国病毒病杂志》2020年第2期118-122,共5页Chinese Journal of Viral Diseases

基　　金：广州市科技计划项目,广州市健康医疗协同创新重大专项(201400000002)。

摘　　要：目的了解人感染H7N9禽流行性感冒(流感)重症患者的免疫状态,提高对重症病例病理的认识,为其免疫调理治疗方案提供临床研究支持。方法对广州市第八人民医院2014年1月-2018年12月确诊的17例人感染H7N9禽流感重症患者的临床资料进行回顾性分析。结果17例患者年龄37~83岁,全部病例符合重症诊断。入院时死亡组患者急性生理与慢性健康评分Ⅱ(APACHEⅡ)明显高于存活组[(28.17±6.62)vs(11.44±6.75),t=-4.738,P<0.001]。入院检查所有重症患者均有不同程度的淋巴细胞及CD4^+T淋巴细胞计数减少,存活组患者经治疗好转后复测淋巴细胞较前明显增加,差异有统计学意义(t=-4.280,P=0.003)。存活组患者CD4^+T淋巴细胞计数明显高于死亡组[187.5(57~434)个/μl vs 79.5(49~168)个/μl,U=2,P=0.034]。入院时10例患者有不同程度降钙素原(PCT)值升高,死亡组与存活组PCT差异有统计学意义(U=4,P=0.015)。住院治疗过程中共有7例患者痰(肺泡灌洗液)培养病原学结果阳性,培养出鲍曼不动杆菌、白色念珠菌、耐甲氧西林金黄色葡萄球菌、烟曲霉菌、肺炎克雷伯菌、耐甲氧西林溶血葡萄球菌等多种病原体。17例患者均接受抗病毒治疗(磷酸奥司他韦、帕拉米韦),3例患者在起病后48h内接受抗病毒治疗,全部存活,14例患者在48h后接受抗病毒治疗,最终6例患者死亡。经治疗17例患者最终存活11例,死亡6例。结论人感染H7N9禽流感重症患者感染后出现严重的免疫功能紊乱,出现急性呼吸窘迫综合征、脓毒症休克及多器官功能障碍综合征,随着感染病程进展,各种淋巴细胞及相关细胞因子水平下调,机体出现免疫麻痹、抑制,从而容易继发各种机会性感染,最终增加病死率。早期(48h内)使用抗病毒药物可能改善临床预后。Objective To understand the immune status of critical patients infected with H7N9avian influenza and their pathological mechanism.Methods The clinical data of 17cases of critical patients infected with H7N9avian influenza from January 2014to December 2018were retrospectively analyzed.Results All 17 cases(37-83years old)were confirmed severe patients.At admission,acute physiological and chronic health scoreⅡ(ApacheⅡ)in the death group was significantly higher than that in the survival group(28.17±6.62 versus 11.44±6.75,t=-4.738,P<0.001).The admission examination showed that all the critical patients had decreased lymphocyte counts and CD4^+T lymphocyte counts to various degrees.The lymphocytes in the survival group significantly increased after treatment and the difference was statistically significant(t=-4.280,P=0.003).CD4^+T lymphocyte counts in the survival group were significantly higher than that in the death group[187.5(57-434)cells/μl vs 79.5(49-168)cells/μl,U=2,P=0.034].At admission,PCT values of 10patients were increased to various degrees,and the difference between the death group and the survival group was statistically significant(U=4,P=0.015).During the hospitalization,7patients showed positive results of sputum culture(alveolar lavage),including Acinetobacter baumannii,Candida albicans,methicillin-resistant Staphylococcus aureus(MRSA),Aspergillus fumigatus,Klebsiella pneumoniae and methicillin-resistant Staphylococcus haemolyticus(MRSH).All patients received treatment of oseltamivir phosphate and peramivir phosphate;3of them received antiviral therapy within 48hours of onset and all survived,while 14of them received antiviral therapy after 48hours of onset and 6patients died.After the treatment,11 patients survived and 6died.Conclusions Severe immune dysfunction occurs after human infection with severe H7N9influenza.The patients develop ARDS,septic shock and MODS.Moreover,with the progression of infection,the levels of various lymphocytes and related cytokines are down-regulated,followed by i

关 键 词：H7N9禽流感 重症患者 免疫 成人 治疗 

分 类 号：R373.1[医药卫生—病原生物学]