CAJ | 학술논문

目的分析2013年4月浙江省人感染H7N9禽流感确诊病例的临床与流行病学特征,探讨其临床特征、感染重点地区和人群及危险因素.方法采用实时荧光定量PCR检测病例和密切接触者咽拭子H7N9禽流感病毒核酸；采用流行病学个案调查与描述性流行病学相结合方法,收集与分析6例确诊病例的临床与流行病学相关资料；采用SPSS 17.0软件进行统计分析.结果 6例人感染H7N9禽流感确诊病例主要分布在杭州和湖州地区,平均年龄60.83(M=64.50)岁,男性多于女性(5∶1)；咳嗽常为首发症状,主要临床表现有发热、头晕、肌肉酸痛、咳嗽、咳痰以及气促、呼吸困难等,胸部影像学均显示严重肺炎,大部分病例(5/6)有慢性基础性疾病.所有病例均无病(死)禽暴露史,但有高频度农贸市场暴露史,其暴露的农贸市场外环境标本H7N9禽流感病毒核酸阳性率达43.21％.6例病例的375名密切接触者中有32人(8.53％)出现异常症状,但咽拭子H7N9禽流感病毒核酸检测均为阴性.结论人感染H7N9禽流感以急性呼吸系统损害为主要临床表现；老年男性,特别是有慢性基础性疾病者是浙江省人感染H7N9禽流感病例的危险人群,其感染来源可能与禽类暴露有关,暂无充分证据支持病毒的人际传播.
목적 분석2013년4월절강성인감염H7N9금류감학진병례적림상여류행병학특정,탐토기림상특정、감염중점지구화인군급위험인소.방법 채용실시형광정량PCR검측병례화밀절접촉자인식자H7N9금류감병독핵산；채용류행병학개안조사여묘술성류행병학상결합방법,수집여분석6례학진병례적림상여류행병학상관자료；채용SPSS 17.0연건진행통계분석.결과 6례인감염H7N9금류감학진병례주요분포재항주화호주지구,평균년령60.83(M=64.50)세,남성다우녀성(5∶1)；해수상위수발증상,주요림상표현유발열、두훈、기육산통、해수、해담이급기촉、호흡곤난등,흉부영상학균현시엄중폐염,대부분병례(5/6)유만성기출성질병.소유병례균무병(사)금폭로사,단유고빈도농무시장폭로사,기폭로적농무시장외배경표본H7N9금류감병독핵산양성솔체43.21％.6례병례적375명밀절접촉자중유32인(8.53％)출현이상증상,단인식자H7N9금류감병독핵산검측균위음성.결론 인감염H7N9금류감이급성호흡계통손해위주요림상표현；노년남성,특별시유만성기출성질병자시절강성인감염H7N9금류감병례적위험인군,기감염래원가능여금류폭로유관,잠무충분증거지지병독적인제전파.
Objective To explore the clinical spectrum,geographic location of human H7N9 avian influenza as well as the characteristics of population at high risk of infection,in order to develop strategies for the prevention and control of the infection.Clinical and epidemiological characteristics on the 6 confirmed human cases in Zhejiang werfe also analyzed.Methods Real-time fluorescent quantitative PCR was used to test the nucleic acid of human H7N9 avian influenza infection,from pharyngeal swabs of the patients and their close contacts.Face to face interview and descriptive method were used to collect related clinical and epidemiological data.Statistical analysis was performed by SPSS 17.0.Results Six confirmed cases were distributed in Hangzhou and Huzhou cities.The 6 confirmed human cases,including 5 males and 1 female were all confirmd with novel influenza A (H7N9) virus infection,with an average age as 60.83 years (with median as 64.50 years).Cough was the most common initial symptom to be noticed.The clinical manifestations would include fever,dizziness,pain of muscles,coughing,expectoration and short of breath.All the X-ray chest films showed severe pneumonia,and 5 of them having had other chronic diseases.None of the cases admitted to have had a history of exposure to ill/death avians.However,all of the cases had been frequently exposed to the agricultural-byproduct-trading-markets where the positive rate of novel influenza A (H7N9) virus in environmental specimens was up to 43.21％.32 of the 375 close contacts (8.53％) to the 6 cases appeared abnormal symptoms,but no positive result related to novel influenza A (H7N9) virus nucleic acid was detected from their throat swabs.Conclusion Acute infection on the respiratory system seemed the main clinical manifestation.Elderly men,especially those with chronic diseases were under high risk of human infection with H7N9 avian influenza.The source of infection might be associated with the exposure to poultry.There was still lack of evidence to confirm the route of person to person transmission on H7N9 avian influenza.