40例甲型H1N1流感病例病原学和临床分析

[目的]探讨甲型H1N1流感的病原学、临床特征和防治方法。[方法]对泉州市40例甲型HlNl流感确诊病例的临床症状,实验室检测、药物治疗以及病毒基因特性等进行分析。[结果]40例确诊病例中,输入性病例16例,本地病例24例,不同性别和各年龄段均可感染和发病,但主要见于青少年,以发热(大多数为中低热)、咽痛、干咳为主要症状,白细胞正常或降低;咽拭子甲型HlNl流感病毒核酸检测均阳性。均收入隔离病房,予达菲及对症支持治疗。40例的体温恢复正常时间为1～4d,咽拭子甲型H1N1流感病毒核酸检测转阴时间为3～6d。甲型H1N1流感病毒具有较高的传染性,核苷酸序列与美国分离株高度同源,与疫苗代表株相比,已出现HA抗原漂移现象,但甲型H1N1流感病毒株毒力较弱,表现较温和,感染者大多表现出轻微的症状,较快痊愈。[结论]加强对确诊病例、密切接触者的隔离和对易感人群进行疫苗接种以及开展流行病学和病原学监测,对防止疫情进一步扩散有重要帮助。     

开封市某中学甲型H1N1流感暴发疫情调查与处置

[目的]了解甲型H1N1流感暴发疫情特点,为控制学校甲型H1N1流感暴发疫情提供科学依据。[方法]采用现场流行病学调查方法,对开封市某中学甲型H1N1流感暴发疫情进行调查,采集病人咽拭子标本,采用Real-time RT-PCR方法进行甲型H1N1流感病毒核酸检测,对病人进行隔离治疗、对密切接触者医学观察、加强疫情监测等。[结果]疫情持续13d,共发生流感样病例40例,其中12例咽拭子标本经实验室检测为甲型H1N1核酸阳性。109名密切接触者经过7d医学观察,未发生续发病例。[结论]此次疫情为开封市首起学校甲型H1N1流感暴发疫情,通过采用现场流行病学调查方法,并采取管理传染源、切断传染途径、加强疫情监测等综合性措施,使疫情迅速得到控制。     

2009年崇左市流感实验室检测结果分析

目的对崇左市2009年流感实验室检测结果进行分析,了解2009年崇左市流感病原学特征,为流感的实验室诊断提供参考。方法收集2009年9—12月崇左市国家流感监测哨点医院及各地送检的流感样病例咽拭子标本561份,应用Real-time RT-PCR技术检测样本中的A M、B NS、H1HA、H3HA、SWH1 NP、SWH1 HA基因。结果 561份标本中,检测到乙型流感病毒核酸阳性27份,季节性流感病毒H1亚型核酸阳性5份,季节性流感病毒H3亚型阳性36份,甲型H1N1病毒特异性基因片段阳性169份,季节性H1和季节性H3流感病毒核酸同时阳性1份。甲型H1N1的检出率较高为30.12%（169/561）,乙型流感病毒核酸阳性率为4.81%（27/561）,季节性H1流感病毒阳性率为0.89%（5/561）,季节性H3流感病毒阳性率为6.42%（36/561）,季节性H1和季节性H3流感病毒核酸同时阳性率为0.18%（1/561）。结论甲型H1N1是2009年崇左市流感的主要毒株类型。     

新型甲型H1N1流感流行期间大连市郊区流感病毒监测分析

目的:了解2009~2010年新型甲型H1N1流感大流行期间,大连市郊区流感病毒的流行情况。方法:对大连市外各区的流感样病人咽拭子标本采用Real-time RT-PCR方法进行流感病毒核酸检测。结果:2009年11月~12月郊区标本均为新型甲型H1N1流感病毒核酸阳性,2010年1月部分地区标本季节性流感病毒核酸阳性,2010年2月后各区标本均季节性流感病毒核酸阳性。结论:2010年1月为新型甲型H1N1流感病毒和季节性流感病毒交替期,之前流行株为新型甲型H1N1流感病毒,之后的流行株为季节性流感病毒。     

泉州市2009年甲型H1N1流感基因特性分析

目的 了解福建省泉州市2009年甲型H1N1流感病毒的HA和NA基因特征,探讨该病毒的遗传变异及分子特性.方法 采集泉州市甲型H1N1流感患者咽拭子,采用实时荧光聚合酶链反应方法检测病毒核酸及MDCK细胞培养进行病毒分离、鉴定,提取其中2株代表性毒株病毒核糖核酸(RNA),采用逆转录-聚合酶链反应(RT-PCR)扩增病毒HA和NA基因,纯化产物进行核苷酸序列测定,用DNAstar megalign软件进行序列分析.结果 1 020份咽拭子检出甲型H1N1流感病毒核酸阳性200份;季节性流感病毒核酸阳性70份,其中H3N2亚型53份,H1N1亚型14份,B型3份,并分离到29株甲型H1N1流感病毒株;HA基因核苷酸序列测定显示,该毒株与北美流行株高度同源,由HA基因核苷酸序列推导的氨基酸系列与疫苗株A/Brisbane/59/2007比较,有22个位于抗原决定簇的氨基酸位点发生变异,但受体结合特异性仍为人样受体,NA基因耐药性位点分析显示,对达菲药物依然敏感.结论 2009年泉州市甲型H1N1流感流行毒株与北美流行株高度同源,相对于疫苗代表株出现了HA蛋白抗原性漂移.     

甲型H1N1流感病毒real-time RT-PCR检测方法的研究与应用

[目的]建立一种特异、灵敏、快速的Real-Time RT-PCR方法用于检测甲型H1N1流感病毒核酸.[方法]采用WHO所推荐的引物与探针序列,对Real-Time RT-PCR反应体系和反应条件进行调整优化,检测该方法的特异性和灵敏度.并对疑似甲型H1N1流感病例咽拭子标本进行检测.[结果]该方法对甲型H1N1流感病毒的检测的灵敏度达10-7(HA滴度为1:128),可从疑似甲流感患者咽拭子中直接检测流感病毒核酸,从病毒核酸提取至完成检测仅需2.5 h左右.[结论]建立的TagMan探针法Real-Time RT-PCR是一种检测甲型H1N1流感病毒的快速、特异、敏感的新方法,适合于基层疾控机构及医院开展甲型H1N1流感的应急检测.     

2013年崇左市流行性感冒实验室检测结果分析

目的对崇左市2013年流行性感冒(流感)实验室控检测结果进行分析,了解2013年崇左市流感病原学特征,为实验室诊断流感提供参考。方法采集2013年崇左市人民医院及各地送检的流感样病例咽拭子标本912份,应用实时反转录聚合酶链反应(real time RT-PCR)技术检测样本中的AM、BNS、H1HA、H3HA、SWH1 HA、H5HA、H9HA、H7HA、N9NA基因。结果 912份标本中,检测到乙型流感病毒核酸阳性19份,季节性流感病毒H1亚型核酸阳性0份,季节性流感病毒H3亚型阳性4份,甲型H1N1病毒特异性基因片段阳性58份,季性性H3和甲型H1N1流感病毒核酸同时阳性1份,均未检测到人感染高致病性禽流感中的H5HA、H9HA、H7HA、N9NA基因。甲型H1N1的检出率较高为6.36%(58/912),阳性构成比为70.73%。乙型流感病毒核酸阳性率为2.08%(19/912),季节性H1流感病毒阳性率为0.00%(0/912),季节性H3流感病毒阳性率为0.44%(4/912),季性性H3和甲型H1N1流感病毒核酸同时阳性率为0.11%(1/912)。均未检测出人感染H5,H9,H7N9禽流感病毒。结论甲型H1N1仍是2013年崇左市流感的主要毒株类型,流行趋势以散发为主,较2009年大暴发流行有所下降。     

茂名市首例甲型H1N1流感病例的实时荧光RT—PCR检测

[目的]对茂名市首例甲型H1N1流感病例进行病毒核酸检测,为甲型H1N1流感疫情的防控提供参考。[方法]采用实时荧光逆转录PCR法对采集的病人咽拭子标本进行甲型H1N1流感病毒核酸检测。[结果]共采集病人2份咽拭子标本,其中1份咽拭子标本的实时荧光RT—PCR检测结果显示H1及N1的RT—PCR反应体系扩增曲线有明显对数增长且Ct值分别为25．21（H1）和25．07（N1）,为甲型H1N1流感病毒核酸阳性;另1份咽拭子标本则呈阴性。后采集第3份咽拭子标本连同第1分标本送广东省疾控中心复检,结果2份标本的甲型H1N1流感病毒核酸检测均为阳性。[结论]这名病人为福建省第2例甲型H1N1流感病毒感染者的密切接触者,由于及时采用灵敏度高,特异性强,检测时间短的实时荧光逆转录PCR方法检测,快速确诊了病例,为疫情的控制争取了时间,防止了2代病例的出现。     

2009年-2011年铁岭市流感样病例病原学监测结果分析

目的:通过流感样病例监测,及时准确对流感病毒进行核酸检测及分型鉴定,快速筛查出甲型H1N1流感病毒,为临床治疗和预防控制提供依据。方法:采集2009年-2011年哨点医院的流感样病例咽拭子标本,采用RT-PCR方法检测流感病毒核酸并进行分型鉴定,再对甲型阳性标本采用Real-time RT-PCR方法筛查出甲型H1N1流感病毒。结果:2009年9月-2011年3月共采集流感样病例标本1292份,核酸阳性标本有110例,经RT-PCR分型鉴定甲型流感病毒71例,占64.55%(H1N1亚型2例占1.82%;H3N2亚型43例占39.09%;SWH1N1亚型26例,占23.64%),乙型流感病毒39例,占35.45%。结论:铁岭市2009年9月-2011年3月流感流行期主要以甲型H3N2亚型为主,并在流感样病例监测中检测出引起世界大流行的新型毒株甲型H1N1型,因此应加大对流感样病例监测检测力度,防止疫情的扩散。     

一起学校甲型H1N1流感疫情调查分析报告

[目的]分析一起学校甲型H1N1流感局部暴发的特点和原因,为制定学校甲型H1N1流感预防控制措施提供依据。[方法]按照卫生部办公厅《甲型H1N1流感流行病学调查和暴发疫情处理技术指南(试行)》和《甲型H1N1流感监测方案(第2版)》要求进行。[结果]本起疫情历时19d,全校累计发生急性发热呼吸道感染病例33例,罹患率为0.98%,确诊病例4例;病例主要集中在4个班,班级罹患率分别为15.49%、19.64%、6.94%和5.45%;男生、女生罹患率分别为1.09%、0.83%;主要临床症状发热100%、咳嗽51.52%、咽痛27.27%、流涕24.24%、鼻塞9.09%;采集鼻咽拭子9份,其中4例甲型H1N1流感病毒核酸阳性。[结论]此为一起由甲型H1N1流感病毒引起的学校局部流感暴发疫情,暴发原因主要为疫情报告迟缓,晨检制度不落实,隔离措施不彻底。     

H1N1 vaccination

Early results (January to April) from the 2010 Canadian Community Health Survey show that an estimated 41% of Canadians (excluding those in the territories) aged 12 or older had been vaccinated for H1N1 by April 2010. The percentages were higher in the Atlantic provinces, Quebec and Saskatchewan than in Canada overall. Relatively high percentages of females and people aged 45 or older were vaccinated; the percentage of immigrants who had done so was relatively low. Being in a priority group (health-care worker, having children younger than 5 in the household, or having a chronic condition that could increase the risk for complications from H1N1) increased the likelihood of vaccination. A history of seasonal flu vaccination and having a regular doctor were also associated with H1N1 vaccination. Nearly three-quarters of those who had not been vaccinated reported that they did not think it was necessary.     

Echo-AM1-1 encephaloscope]

A new miniature model of the A-mode ultrasonic echoencephaloscope, 0.88 MHz, has been developed and adopted to practical use in neurology. The device contains a detector for amplitude determination of echopulsation and curve (echopulsograms) recording. It is highly sensitive, cost-effective, which enhances the quality of rapid diagnosis of central nervous diseases, including those of vascular genesis, in in- and outpatient settings.     

被动吸烟与cyp1b1、gstp1、sult1a1基因多态性对乳腺癌发病的影响

目的 探讨被动吸烟、cyp1b1、gstp1、sult1a1基因多态性及其联合作用对乳腺癌发病的影响。方法 2014 - 2015年间,采用病例-对照研究方法,收集病例794例,对照805例。问卷调查收集研究对象信息。采用飞行质谱技术,进行cyp1b1、gstp1、sult1a1基因单核苷酸多态性分型检测。采用多因素非条件 logistic 回归,分析环境烟草烟雾暴露及cyp1b1、gstp1、sult1a1基因多态性与乳腺癌发病风险的关系。结果 调整年龄、教育程度、家庭年总收入、职业、婚姻状况后,环境烟草烟雾暴露与gstp1基因多态性未发现协同作用。以环境烟草烟雾低暴露且携带 cyp1b1 rs1056836 C等位基因为参照,环境烟草烟雾高暴露且携带 GG 基因在绝经前女性中乳腺癌风险明显增高（OR = 1.678,95%CI:1.039～2.711）。以环境烟草烟雾组合低暴露且携带sult1a1 rs9282861GG基因型为参照,环境烟草烟雾高暴露且携带A等位基因绝经前乳腺癌风险明显增高（OR = 2.389,95%CI:1.157～4.931）,但交互作用系数无统计学意义。结论 环境烟草烟雾高暴露与cyp1b1 及sult1a1基因对乳腺癌发病风险可能存在协同作用,但尚扩大样本进行验证。     

接种甲型H1N1流感疫苗后患甲型H1N1流感分析

目的 分析接种甲型H1N1流感疫苗后发生甲型H1N1流感感染的病例,探讨发病原因,为进一步提高疫苗预防效果提供参考依据.方法 对接种甲型H1N1流感疫苗后发生甲型H1N1流感感染148例,进行回顾性调查分析.结果 接种甲型H1N1流感疫苗11176例.发生甲型H1N1感染148例,感染率1.32%,其中1～14 d感染81例,感染率0.72%,＞15 d感染67例,感染率0.60%.结论 甲型H1N1流感病毒裂解疫苗是一种安全高效的疫苗,不足之处尚待进一步探讨、完善.     

NF1 gene and neurofibromatosis 1

Neurofibromatosis 1 (NF1), also known as von Recklinghausen disease, is an autosomal dominant condition caused by mutations of the NF1 gene, which is located at chromosome 17q11.2. NF1 is believed to be completely penetrant, but substantial variability in expression of features occurs. Diagnosis of NF1 is based on established clinical criteria. The presentation of many of the clinical features is age dependent. The average life expectancy of patients with NF1 is probably reduced by 10-15 years, and malignancy is the most common cause of death. The prevalence of clinically diagnosed NF1 ranges from 1/2,000 to 1/5,000 in most population-based studies. A wide variety of NF1 mutations has been found in patients with NF1, but no frequently recurring mutation has been identified. Most studies have not found an obvious relation between particular NF1 mutations and the resulting clinical manifestations. The variability of the NF1 phenotype, even in individuals with the same NF1 gene mutation, suggests that other factors are involved in determining the clinical manifestations, but the nature of these factors has not yet been determined. Laboratory testing for NF1 mutations is difficult. A protein truncation test is commercially available, but its sensitivity, specificity, and predictive value have not been established. No general, population-based molecular studies of NF1 mutations have been performed. At this time, it appears that the benefits of population-based screening for clinical features of NF1 would not outweigh the costs of screening.     

GSTM1及GSTT1和GSTP1基因多态性对尿中1-羟基芘水平的影响

目的 研究GSTM1、GSTT1和GSTP1基因多态性对多环芳烃接触工人尿中1-羟基芘(1-OHP)水平的影响.方法 分别选取2个炼焦厂共447名多环芳烃职业接触工人(接触组)和某线材厂220名非职业接触工人(对照组)作为研究对象,采用高效液相色谱法测定尿中1-OHP水平,采用线性回归统计模型分析GSTM1和GSTT1缺失型及GSTP1 I105V位点的多态性对不同人群尿中1-OHP水平的修饰作用.结果 接触组工人尿中1-OHP浓度为4.61 μmol/mol Cr,明显高于对照组(0.34μmol/mol Cr),差异有统计学意义(P＜0.05).接触类别和吸烟分别是影响尿中1-OHP水平的主要因素,在控制各混杂因素的影响后,线性回归分析显示,接触组尿中1-OHP水平和GSTP1 I105V位点多态性有关(单基因分析,P=0.012;多基因分析,P=0.011),对总体样本,单基因模型和多基因模型均显示,尿中1-OHP水平可能和GSTT1缺失型多态有关(P=0.055),多基因交互作用分析显示,GSTT1和GSTP1基因多态对接触组尿中1-OHP水平具有交互作用.结论 谷胱甘肽硫转移酶(GSTs)基因的多态性对接触多环芳烃工人尿中1-OHP水平有影响.

Abstract：

Objective To investigate the modification of GSTM1, GSTT1 and GSTP1 gene polymorphisms on urinary 1-hydroxypyrene (1-OHP) excretions in workers under different exposure levels. Methods Four hundred and forty-seven occupationally exposed workers from two coking plants and 220 control workers from a wire rod plant were genotyped to analyze the modification of GSTM1, GSTT1 and GSTP1 gene polymorphisms on urinary 1-OHP excretions. Results The urinary 1-OHP concentration in exposed group was much higher than that in control group (4.61 vs 0.34 μmol/mol Cr, P＜0.05). Occupational exposure levels and cigarette smoking were of the dominating factors affecting 1-OHP excretions in urine. After controlling potential confounders, decreased excretion of urinary 1-OHP was associated with GSTP1 I105V AG + GG genotype in coke oven workers (single-gene model, P=0.012; multi-gene model, P=0.011 ) and with GSTT1 null type in the analysis including all subjects (P=0.055 in both single-gene and multi-gene models). GSTT1 and GSTP1 were interacted on the urinary concentrations of 1-OHP. Conclusion Urinary 1-OHP concentrations can be modified by GSTM1, GSTT1 and GSTP1 gene polymorphisms, indicating that these genes are involved in the metabolism of polycyclic aromatic hydrocarbons.     

Protective efficacy of an inactivated Eurasian avian-like H1N1 swine influenza vaccine against homologous H1N1 and heterologous H1N1 and H1N2 viruses in mice

Eurasian avian-like H1N1 (EA H1N1) swine influenza viruses are prevalent in pigs in Europe and Asia, but occasionally cause human infection, which raises concern about their pandemic potential. Here, we produced a whole-virus inactivated vaccine with an EA H1N1 strain (A/swine/Guangxi/18/2011, SW/GX/18/11) and evaluated its efficacy against homologous H1N1 and heterologous H1N1 and H1N2 influenza viruses in mice. A strong humoral immune response, which we measured by hemagglutination inhibition (HI) and virus neutralization (VN), was induced in the vaccine-inoculated mice upon challenge. The inactivated SW/GX/18/11 vaccine provided complete protection against challenge with homologous SW/GX/18/11 virus in mice and provided effective protection against challenge with heterologous H1N1 and H1N2 viruses with distinctive genomic combinations. Our findings suggest that this EA H1N1 vaccine can provide protection against both homologous H1N1 and heterologous H1N1 or H1N2 virus infection. As such, it is an excellent vaccine candidate to prevent H1N1 swine influenza.