中国高致病性禽流感A/H5N1病毒感染患者的临床与预后
중국고치병성금류감A/H5N1병독감염환자적림상여예후
Relationship between clinical features and prognosis of highly pathogenic avian influenza A/H5N1 infection in humans in mainland China
  • 万方数据
    中华结核和呼吸杂志 중화결핵화호흡잡지
    Chinese Journal of Tuberculosis and Respiratory Diseases
    2009年 5期 335-341 ,共7页

    李佳%徐钰%陈余清%葛阳%章隆辉%徐晓玲%吴同生%陈愉生%王静%刘建南%魏立平%邱晨%钟小宁%黄美杏%辛建保%罗如平%赵明顺%李再清%胡成平%赵伟%王虹%张伟%郭路生%王秋月%周龙女%梁宗安%马俊清%刘跃建%蒋远明%谢万升%盛吉芳%高占成

    리가%서옥%진여청%갈양%장륭휘%서효령%오동생%진유생%왕정%류건남%위립평%구신%종소저%황미행%신건보%라여평%조명순%리재청%호성평%조위%왕홍%장위%곽로생%왕추월%주룡녀%량종안%마준청%류약건%장원명%사만승%성길방%고점성

    禽流感%流感病毒A型%治疗%预后 禽流感%流感病毒A型%治療%預後
    금류감%류감병독A형%치료%예후
    Influenza in birds%Influenza A virus%Therapy%Prognosis
    目的 研究我国卫生部公布的28例高致病性禽流感A/H5 N1病毒感染(简称人禽流感)病例的临床特点,评估其临床与预后的相关性.方法 回顾总结我国2005年11月至2008年5月临床及实验室确诊的28例人禽流感病例的临床资料,应用EPIDATA 3.02建立数据库,并应用SPSS13.0软件进行统计分析,计量资料采用独立样本非参数检验,计数资料应用x<'2>(fisher)检验.结果 我国28例人禽流感病例中,男13例,女15例,治愈10例,死亡18例.发病中位年龄为29岁(6～62岁),发热为本病最突出的临床表现(100%).治愈患者首次血常规检测白细胞为(4.0±1.9)×109/L,淋巴细胞为(1.09±0.49)×109/L,,血小板为(116±39)x 109/L;死亡患者分别为(5.1±2.9)x 109/L、(0.98±0.44)x109/L 及(101±40)x109/L,两组比较差异均无统计学意义(P>0.05).治愈与死亡患者天冬氨酸转氨酶分别为(173±246)U/L和(272±263)U/L,乳酸脱氢酶(LDH)分别为(1016±568)U/L和(1512±1052)U/L,肌酸激酶分别为(1099±1590)U/L和(2534±4281)U/L,肌酸激酶同T酶分别为(28±30)U/L和(125±197)U/L.死亡患者发病初期LDH水平大于正常值上限8倍以上者6例.疾病极期均出现舣侧肺部病变.22例发展为急性呼吸窘迫综合征,其中治愈患者中5例,死亡患者中17例;急性肾损伤9例,均死亡.奥司他书抗病毒治疗的10例中,6例康复,4例死亡,康复和死亡患者开始使用奥司他韦的时间分别为(6.5±3.0)d和(11.8±3.3)d.28例患者均不同程度接受丁抗牛素和糖皮质激素治疗,开始碰用糖皮质激素的时间和疗程治愈患者与死亡患卉无差异.结论 (1)发病初期LDH升高大于正常上限8倍以上者预后不良;(2)合并急性呼吸窘迫综合征及急性肾损伤者预后差;(3)发病早期应用有效抗病毒治疗可改善预后.
    목적 연구아국위생부공포적28례고치병성금류감A/H5 N1병독감염(간칭인금류감)병례적림상특점,평고기림상여예후적상관성.방법 회고총결아국2005년11월지2008년5월림상급실험실학진적28례인금류감병례적림상자료,응용EPIDATA 3.02건립수거고,병응용SPSS13.0연건진행통계분석,계량자료채용독립양본비삼수검험,계수자료응용x<'2>(fisher)검험.결과 아국28례인금류감병례중,남13례,녀15례,치유10례,사망18례.발병중위년령위29세(6～62세),발열위본병최돌출적림상표현(100%).치유환자수차혈상규검측백세포위(4.0±1.9)×109/L,림파세포위(1.09±0.49)×109/L,,혈소판위(116±39)x 109/L;사망환자분별위(5.1±2.9)x 109/L、(0.98±0.44)x109/L 급(101±40)x109/L,량조비교차이균무통계학의의(P>0.05).치유여사망환자천동안산전안매분별위(173±246)U/L화(272±263)U/L,유산탈경매(LDH)분별위(1016±568)U/L화(1512±1052)U/L,기산격매분별위(1099±1590)U/L화(2534±4281)U/L,기산격매동T매분별위(28±30)U/L화(125±197)U/L.사망환자발병초기LDH수평대우정상치상한8배이상자6례.질병겁기균출현의측폐부병변.22례발전위급성호흡군박종합정,기중치유환자중5례,사망환자중17례;급성신손상9례,균사망.오사타서항병독치료적10례중,6례강복,4례사망,강복화사망환자개시사용오사타위적시간분별위(6.5±3.0)d화(11.8±3.3)d.28례환자균불동정도접수정항우소화당피질격소치료,개시팽용당피질격소적시간화료정치유환자여사망환훼무차이.결론 (1)발병초기LDH승고대우정상상한8배이상자예후불량;(2)합병급성호흡군박종합정급급성신손상자예후차;(3)발병조기응용유효항병독치료가개선예후.
    Objective To investigate the relationship between clinical features of patients with A/H5N1 infection and their prognosis in mainland China Methods This study included 28 human cases with A/H5 N1 infection in mainland China from October 2005 to May 2008.Data were collected and reviewed from hospital medical records and publishied papers.A database was built by EPIDATA 3.02 and statistical analyses were performed with SPSS 13.0.Results The median age of the 28 cases was 29 years (range 6 -62),and 15 were females.Ten patients survived,and 18 died.The typically clinical manifestations of human influenza A/H5N1 infection included fever and lower respiratory infection.The numbers of peripheral white blood cells,lymphocytes and platelets in the survival and non-survival groups were (4.01±1.86) x 109/L vs (5.1 ±2.9) x 109/L,(1.09±0.49) x 109/L vs (0.98 ±0.44) x 109/L,and (116±39) x 109/L vs (101±40) x 109/L,respectively;the differences were not statistically significant between the 2 groups (P > 0.05).There was also no statistically significant difference in the increased serum enzymes,such as aspartate aminotransferase [(173 ±246)U/L vs (272±263)U/L],lactate dehydrogenase [(1016±568) U/L vs (1512±1052) U/L],creatine kinase [(1099±1590) U/L vs (2534±4281) U/L]and MB isoenzyme of creatine kinase [(28±30) U/L us (125±197) U/L](P > 0.05) between the survival and the non-survival groups.However,there was a statistically significant difference in the number of patients with an initial LDH level more than 8 fold of the normal value between the survival and the non-survival groups (none vs 6,P < 0.05).All of the 28 cases developed bilateral multiple infiltrates andconsolidation in chest radiographs.Acute respiratory distress syndrome occurred in 22 cases,17 of them died.All the 9 patients with acute kidney injury died.Ten patients received antiviral treatment with oseltamivir,and 6 of them survived.There was a statistical difference in the time of initiating oseltamivir treatment between the survival and the non-survival cases [(6.5±3.0) d vs (11.8±3.3) d,Z = 3.70,P < 0.05].Broad spectrum antibiotics and corticosteroids were administered in all of the 28 eases.There was no statistical difference between the survival and the non-survival groups regarding to the corticesteroid treatment (P >0.05).Conclusions Initial LDH level reaching more than 8 fold of the normal value suggests a poor prognosis for human H5N1 infection.Patients complicated with either ARDS or acute kidney injury had a higher risk of death.Early administration of effective anfiviral agents might improve the prognosis and decrease case fatality.
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