陕西地区首发3例人感染H7N9重症禽流感救治临床研究
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摘要
目的:分析陕西地区首发3例人感染H7N9重症禽流感患者的临床特征及救治特点,为H7N9禽流感的合理防治提供依据。方法:对2017年5月收治的3例人感染H7N9重症病例进行回顾性分析。结果:3例患者中,男2例,女1例,年龄52～76岁。1例院前有H7N9禽流感患者密切接触史。发病初期均有发热、咳嗽等表现,后期出现重症肺炎; 2例合并肝功能损害、凝血功能紊乱和双下肢深静脉血栓。患者病程初期白细胞计数(WBC)正常或偏低,中性粒细胞百分率(N%)升高,淋巴细胞百分率(L%)降低;病程后期N%下降,L%升高;病程初期C反应蛋白(CRP)、血沉(ESR)升高。3例患者胸部影像学示肺实变及磨玻璃影,伴少量胸腔积液;2例肺部超声示重度肺泡-间质综合征,伴肺实变。入院后经抗病毒、抗炎、抗凝、免疫调节、机械通气及营养支持治疗,全部康复出院。结论:重症H7N9禽流感病情进展迅速,病程中易合并多种并发症。早期诊断、早期抗病毒基础上的综合支持治疗是救治成功的关键。
Objective: To analyze the clinical features and treatment characteristics of the first 3 human cases of H7 N9 severe avian influenza in Shaanxi province, and to provide evidence for the rational prevention and treatment on H7 N9 avian influenza. Methods: The clinical data of the 3 cases of severe human avian influenza infected by H7 N9 influenza virus, admitted to our department in May 2017 were retrospectively analyzed. Results: Of the 3 patients enrolled, including 2 males and 1 female, ranging from 52 to 76 years old. One case had closely contact history with H7 N9 avian influenza patient before hospitalization. All the patients manifested fever, cough during the initial stage, with severe pneumonia during the later stage. Two cases were complicated by liver dysfunction, coagulation disorder and deep venous thrombosis of both lower extremities. The white blood cell counts(WBC) was normal or low during the early stage of the disease, with increasing neutrophil percentage(N%) and decreasing lymphocyte percentage(L%), while with increased L% and decreased N% during the late stage. C reactive protein(CRP) and erythrocyte sedimentation rate(ESR) were elevated during the initial stage. Chest imaging of 3 patients showed pulmonary consolidation and ground-glass shadow, with a small amount of pleural effusion.The pulmonary ultrasonography of 2 cases showed severe alveolar-interstitial syndrome accompanied by pulmonary consolidation. All the patients were recovered and discharged after antiviral, antiinflammatory, anticoagulant, immune regulatory, mechanical ventilation and nutritional supporting therapy. Conclusion: The clinical course of severe H7 N9 avian influenza progresses rapidly, and is usually to be complicated by multiple complications. Comprehensive supporting treatment based upon early diagnosis and early antiviral therapy is the key point to successful remedy.
Objective: To analyze the clinical features and treatment characteristics of the first 3 human cases of H7 N9 severe avian influenza in Shaanxi province, and to provide evidence for the rational prevention and treatment on H7 N9 avian influenza. Methods: The clinical data of the 3 cases of severe human avian influenza infected by H7 N9 influenza virus, admitted to our department in May 2017 were retrospectively analyzed. Results: Of the 3 patients enrolled, including 2 males and 1 female, ranging from 52 to 76 years old. One case had closely contact history with H7 N9 avian influenza patient before hospitalization. All the patients manifested fever, cough during the initial stage, with severe pneumonia during the later stage. Two cases were complicated by liver dysfunction, coagulation disorder and deep venous thrombosis of both lower extremities. The white blood cell counts(WBC) was normal or low during the early stage of the disease, with increasing neutrophil percentage(N%) and decreasing lymphocyte percentage(L%), while with increased L% and decreased N% during the late stage. C reactive protein(CRP) and erythrocyte sedimentation rate(ESR) were elevated during the initial stage. Chest imaging of 3 patients showed pulmonary consolidation and ground-glass shadow, with a small amount of pleural effusion.The pulmonary ultrasonography of 2 cases showed severe alveolar-interstitial syndrome accompanied by pulmonary consolidation. All the patients were recovered and discharged after antiviral, antiinflammatory, anticoagulant, immune regulatory, mechanical ventilation and nutritional supporting therapy. Conclusion: The clinical course of severe H7 N9 avian influenza progresses rapidly, and is usually to be complicated by multiple complications. Comprehensive supporting treatment based upon early diagnosis and early antiviral therapy is the key point to successful remedy.
引文
[1] Gao R, Cao B, Hu Y, et al. Human infection with a novel avian-origin influenza A (H7N9) virus.[J]. New England Journal of Medicine, 2013,368(20):1888.
[2] 郭雅玲, 马羽萍, 许荣放, 等. 甲型H1N1流感1363例临床特点分析[J]. 陕西医学杂志, 2011,40(10):1346-1348.
[3] Gao HN, Lu HZ, Cao B, et al. Clinical findings in 111 cases of influenza A (H7N9) virus infection.[J]. N Engl J Med, 2013,368(24):2277-2285.
[4] 国家卫生和计划生育委员会. 人感染H7N9禽流感诊疗方案(2017年第1版)[J]. 中国病毒病杂志, 2017,30(1):1-4.
[5] Xunbo DU, Yang L, Yue Y, et al. Survey report on the first case of human infection of H5N1 avian influenza in Chengdu in 2016[J]. Journal of Preventive Medicine Information, 2018,34(2):20-23.
[6] Yang ZF, Mok CK, Peiris JS, et al. Human infection with a novel avian influenza A(H5N6) virus[J]. N Engl J Med, 2015,373(5):487-489.
[7] Liu D, Shi W, Shi Y, et al. Origin and diversity of novel avian influenza A H7N9 viruses causing human infection: phylogenetic, structural, and coalescent analyses[J]. Lancet, 2013,381(9881):1926-1932.
[8] 王琦梅, 刘社兰, 陈恩富. 人感染H7N9禽流感流行病学研究进展[J]. 中华预防医学杂志, 2017,51(2):183-187.
[9] 任瑞琦, 周蕾, 向妮娟, 等. 中国内地人感染H7N9禽流感疫情流行病学特征分析[J]. 中华流行病学杂志, 2014,35(12):1362-1365.
[10] 王逸平, 赵宏胜. 人感染H7N9禽流感重症病例3例临床特点分析[J]. 南通大学学报:医学版, 2017,37(2):132-135.
[11] 夏洪韬, 曹霖, 何正光, 等. 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[J]. 中国呼吸与危重监护杂志, 2017,16(2):103-108.
[12] Chen Y, Liang W, Yang S, et al. Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome[J]. Lancet, 2013,381(9881):1916-1925.
[13] Liu CX, Laboratory DO. Molecular biology diagnostic technique of H7N9 avian influenza virus[J]. Occupation & Health, 2018,(2):143-146.
[14] 林丽雅, 陈聚兴, 伍尚剑, 等. H7N9禽流感患者生化指标的临床价值研究[J]. 实用医技杂志, 2016,23(8):824-826.
[15] 陈聚兴, 陈瑞丽, 伍尚剑. 感染性指标对人感染H7N9禽流感的诊疗价值研究[J]. 中国实用医药, 2016,11(20):92-94.
[16] 陆普选, 曾政, 郑斐群, 等. 人感染H7N9禽流感病毒性重症肺炎的影像学表现及动态变化特点[J]. 放射学实践, 2014,29(7):740-744.
[17] 谢陈. 人感染H7N9 禽流感病毒的胸部影像学表现[J]. 实用医院临床杂志, 2018,(3):205-207.
[18] Sartori S, Tombesi P. Emerging roles for transthoracic ultrasonography in pulmonary diseases[J]. World Journal of Radiology, 2010,10(6):203-214.
[19] Reissig A, Copetti R, Mathis G, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study[J]. Chest, 2012,142(4):965-972.
[20] Americo T, Gino S, Roberto C, et al. Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound[J]. Critical Care, 2012,16(1):R30.
[21] 沈鹏, 宗酉明, 殳儆, 等. 超声在评估人感染H7N9禽流感肺部病变中的应用[J]. 中华急诊医学杂志, 2014,23(2):224-226.
[22] Liu Y, Cai S, Huang H, et al. Application of pulmonary ultrasound in severe human infection with H7N9 avian influenza[J]. China Medicine & Pharmacy, 2018,8(5):23-25,46.
[23] 李丹, 谭琴, 龙云铸. 抗病毒与免疫调节治疗H7N9禽流感研究进展[J]. 中国感染控制杂志, 2015,14(10):717-720.
[24] Nicholson KG, Aoki FY, Osterhaus AD, et al. Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial. Neuraminidase Inhibitor flu treatment investigator group[J]. Lancet, 2000,355(9218):1845-1850.
[25] Chen H Y, Zhang J. Effect of combination with the thymosin alpha 1 in elderly severe pneumonia[J]. Modern Medical Journal, 2013,50(4):41-44.
[26] Mingxia JI, Xiaoshui SI, Jianxin HE. Efficacy of thymosin-α1 for patients with severe pneumonia[J]. Zhejiang Medical Journal, 2015,37(9):738-740.
[27] Confalonieri M, Meduri GU. Glucocorticoid treatment in community-acquired pneumonia[J]. Lancet, 2011,377(9782):1982-1984.
[28] 姚贵江, 姜娟. 无创机械通气在危重症甲型H1N1流感并呼吸衰竭中的疗效[J]. 中国临床研究, 2013,26(3):225-226.
[2] 郭雅玲, 马羽萍, 许荣放, 等. 甲型H1N1流感1363例临床特点分析[J]. 陕西医学杂志, 2011,40(10):1346-1348.
[3] Gao HN, Lu HZ, Cao B, et al. Clinical findings in 111 cases of influenza A (H7N9) virus infection.[J]. N Engl J Med, 2013,368(24):2277-2285.
[4] 国家卫生和计划生育委员会. 人感染H7N9禽流感诊疗方案(2017年第1版)[J]. 中国病毒病杂志, 2017,30(1):1-4.
[5] Xunbo DU, Yang L, Yue Y, et al. Survey report on the first case of human infection of H5N1 avian influenza in Chengdu in 2016[J]. Journal of Preventive Medicine Information, 2018,34(2):20-23.
[6] Yang ZF, Mok CK, Peiris JS, et al. Human infection with a novel avian influenza A(H5N6) virus[J]. N Engl J Med, 2015,373(5):487-489.
[7] Liu D, Shi W, Shi Y, et al. Origin and diversity of novel avian influenza A H7N9 viruses causing human infection: phylogenetic, structural, and coalescent analyses[J]. Lancet, 2013,381(9881):1926-1932.
[8] 王琦梅, 刘社兰, 陈恩富. 人感染H7N9禽流感流行病学研究进展[J]. 中华预防医学杂志, 2017,51(2):183-187.
[9] 任瑞琦, 周蕾, 向妮娟, 等. 中国内地人感染H7N9禽流感疫情流行病学特征分析[J]. 中华流行病学杂志, 2014,35(12):1362-1365.
[10] 王逸平, 赵宏胜. 人感染H7N9禽流感重症病例3例临床特点分析[J]. 南通大学学报:医学版, 2017,37(2):132-135.
[11] 夏洪韬, 曹霖, 何正光, 等. 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[J]. 中国呼吸与危重监护杂志, 2017,16(2):103-108.
[12] Chen Y, Liang W, Yang S, et al. Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome[J]. Lancet, 2013,381(9881):1916-1925.
[13] Liu CX, Laboratory DO. Molecular biology diagnostic technique of H7N9 avian influenza virus[J]. Occupation & Health, 2018,(2):143-146.
[14] 林丽雅, 陈聚兴, 伍尚剑, 等. H7N9禽流感患者生化指标的临床价值研究[J]. 实用医技杂志, 2016,23(8):824-826.
[15] 陈聚兴, 陈瑞丽, 伍尚剑. 感染性指标对人感染H7N9禽流感的诊疗价值研究[J]. 中国实用医药, 2016,11(20):92-94.
[16] 陆普选, 曾政, 郑斐群, 等. 人感染H7N9禽流感病毒性重症肺炎的影像学表现及动态变化特点[J]. 放射学实践, 2014,29(7):740-744.
[17] 谢陈. 人感染H7N9 禽流感病毒的胸部影像学表现[J]. 实用医院临床杂志, 2018,(3):205-207.
[18] Sartori S, Tombesi P. Emerging roles for transthoracic ultrasonography in pulmonary diseases[J]. World Journal of Radiology, 2010,10(6):203-214.
[19] Reissig A, Copetti R, Mathis G, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study[J]. Chest, 2012,142(4):965-972.
[20] Americo T, Gino S, Roberto C, et al. Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound[J]. Critical Care, 2012,16(1):R30.
[21] 沈鹏, 宗酉明, 殳儆, 等. 超声在评估人感染H7N9禽流感肺部病变中的应用[J]. 中华急诊医学杂志, 2014,23(2):224-226.
[22] Liu Y, Cai S, Huang H, et al. Application of pulmonary ultrasound in severe human infection with H7N9 avian influenza[J]. China Medicine & Pharmacy, 2018,8(5):23-25,46.
[23] 李丹, 谭琴, 龙云铸. 抗病毒与免疫调节治疗H7N9禽流感研究进展[J]. 中国感染控制杂志, 2015,14(10):717-720.
[24] Nicholson KG, Aoki FY, Osterhaus AD, et al. Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial. Neuraminidase Inhibitor flu treatment investigator group[J]. Lancet, 2000,355(9218):1845-1850.
[25] Chen H Y, Zhang J. Effect of combination with the thymosin alpha 1 in elderly severe pneumonia[J]. Modern Medical Journal, 2013,50(4):41-44.
[26] Mingxia JI, Xiaoshui SI, Jianxin HE. Efficacy of thymosin-α1 for patients with severe pneumonia[J]. Zhejiang Medical Journal, 2015,37(9):738-740.
[27] Confalonieri M, Meduri GU. Glucocorticoid treatment in community-acquired pneumonia[J]. Lancet, 2011,377(9782):1982-1984.
[28] 姚贵江, 姜娟. 无创机械通气在危重症甲型H1N1流感并呼吸衰竭中的疗效[J]. 中国临床研究, 2013,26(3):225-226.