甲型H1N1流感病例临床分析

目的 分析甲型H1N1流感的流行和临床特点.方法 回顾性分析首都医科大学附属北京佑安医院2009年5至8月间收治的137例甲型H1N1流感病毒感染者的临床资料.结果 流行早期患者以输入性病例为主,主要来自美国、澳大利亚、加拿大,英国,后期为续发病例为主.发病年龄以儿童和青少年为主;临床主要表现为发热(108例)、咳嗽(93例)、咽部不适(67例).最常见的体征:咽充血(99例)和扁桃体肿大(46例).平均热程(3.3±1.5)d,症状消失时间平均(4.4±1.9)d.平均住院时间(5.5 ±2.1)d.实验室检查:39例(39.5%)外周血白细胞计数降低(3.3±0.4)×109/L,淋巴细胞百分比升高;甲型H1N1流感病毒核酸均阳性;胸部X线表现为肺纹理增强、模糊和肺炎表现.治疗:中药组、西药+中药组、对症或未用药组3组疗效对热程、症状消失时间、甲型H1N1流感病毒核酸转阴时间差异均无统计学意义.结论 甲型H1N1流感可为隐性感染和显性感染,传染性强、临床症状轻,临床过程多为自限性、轻症病例,类似季节性流感.     

335例甲型H1N1流感病例流行病学分析

目的 探讨甲型H1N1流感的流行病学特征.方法 回顾性分析2009年6月至2010年1月确诊的335例甲型H1N1流感患者的流行病学资料,分析普通型与危-重型患者的流行病学特点.结果 2009年10月前患者多有甲型H1N1流感接触史,病情轻;2009年11月至2010年1月患者少有甲型H1N1流感接触史,危-重型患者增...     

Viral shedding in Chinese young adults with mild 2009 H1N1 influenza

Background  The duration of viral shedding and the transmission of 2009 H1N1 influenza among individuals, especially among the younger population with mild illness, are not well understood now. The aim of this study was to determine the viral shedding of the young adult patients with mild 2009 H1N1 influenza in China.

Methods  From September 2009 to January 2010, the clinical data and serial nasopharyngeal swabs of 67 patients with 2009 H1N1 influenza and 37 patients with seasonal influenza aged from 18 years to 35 years were collected. The nasopharyngeal swab samples were detected by real time RT-PCR to determine the viral shedding. All the patients did not receive the antiviral therapy but Chinese medicine for detoxicating.

Results  Among the patients with H1N1 virus infection, 82.1% (55/67) patients presented with fever symptom, while more patients with high fever (≥39ºC) were found in seasonal influenza patients (P <0.05). For the H1N1 patients, the median interval between the symptom onset and the undetectable RNA was six days (4–10 days). But viral shedding was still found in 31.3% patients after 7 days following illness onset. The median interval between disappearance of fever and an undetectable viral RNA level was three days (2–8 days), and 17.9% patients were found to be viral shedding 6 days later after normalization of body temperature. For the seasonal influenza patients, 94.6% patients were detected out viral RNA within 7 days. The median interval of seasonal influenza between the symptom onset and the undetectable RNA was four days (3–8 days). The median interval between disappearance of fever and an undetectable viral RNA level was three days (2–6 days).

Conclusion  It suggests that 7 days isolation period from the illness onset or 24 hours after the resolution of fever and respiratory symptoms are not long enough to cut off the transmission among Chinese young adults with mild illness.

     

深圳地区新甲型H1N1（2009）流感病毒M基因特征分析

目的对深圳地区分离到的新甲型H1N1（2009）流感病毒的M基因分子特性进行详细分析,并从分子水平上了解其对金刚烷胺类药物的耐药性。方法选取深圳地区分离培养到的55株新甲型H1N1（2009）流感病毒,对其M片段进行全长测序,采用DNAstar与MEGA3．1生物软件对M基因序列进行比对并用NJ法构建系统进化树。结果通过对M基因的氨基酸序列进行进化分析,发现深圳地区分离培养到的新甲型H1N1（2009）流感病毒更接近欧洲猪流感病毒,与季节性HINI流感病毒差异很大。经过序列分析发现,深圳株的M基因与A／California／07／2009高度同源,显示该病毒M基因较保守。此外,还发现所有深圳株的M2蛋白均出现s31N突变,显示对金刚烷胺类药物可能耐药。结论深圳流行的新甲型H1N1（2009）流感病毒的M基因可能源于欧洲猪流感病毒,且均对金刚烷胺类药物有耐药倾向。应进一步加强对新甲型H1N1（2009）流感病毒的分子特征研究,并积极开展流感病毒耐药性监测。     

Sixty-two severe and critical patients with 2009 influenza A (H1N1) in Shanghai, China

Background  Pandemic influenza A (H1N1) emerged rapidly in China in May 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A (H1N1) disproportionately affects younger ages and causes generally mild disease. To characterize disease progress, comorbidities, and treatment outcomes among consecutive severe and critically ill patients in a hospital served as a reference center for the care of patients with H1N1 in Shanghai, China.

Methods  A retrospective study on 62 severe and critically ill patients with 2009 influenza A (H1N1) was conducted in Shanghai Public Health Clinical Center. Demographic data, symptoms, comorbidities, disease progression, treatments, and clinical outcomes were collected for analysis.

Results  Sixty-two severe or critically ill patients were admitted to the hospital with confirmed 2009 influenza A (H1N1) infection. The median age of the study cohort was 40 years old with a range from 18 years to 75 years, and 67.7% were males. All patients presented with fever and respiratory symptoms. At presentation, 34 patients (54.8%) had comorbidities such as smoking (29.0%), hypertension (29.0%) and hepatitis B virus infection (9.7%). The median time from symptom onset to hospital admission was 6 days (interquartile-range 3–14 days) and 23 critically ill patients were admitted to Intensive Care Unit after admission. All the patients received neuraminidase inhibitors (oseltaminir), while 60 patients (96.7%) were treated with antibiotics, and 39 (62.9%) with corticosteroids. Twenty-three critical cases received noninvasive mechanical ventilation on the first day of admission, and 3 of them ultimately required invasive ventilation. Four death reports (6.5%) were filed within the first 14 days from the onset of critical illness with the primary causes of severe acute respiratory distress syndrome, hypoxemia, or complications, secondary infection and sepsis, pyopneumothorax and stroke.

Conclusions  Severe illness from 2009 influenza A (H1N1) infection in Shanghai occurred among young individuals. Critical cases were associated with severe hypoxemia, multisystem organ failure, and a requirement for mechanical ventilation. Most patients had a good prognosis.

     

甲型H1N1、季节性H1N1及H3N2亚型流感病毒的多重荧光RT-PCR方法的建立

目的构建一种可同时检测甲型H1N1、季节性H1N1、H3N2亚型流感病毒的多重荧光RT-PCR方法。方法根据不同流感亚型HA与NA的差异,设计五对引物及五条探针,构建合适的检测体系,分析特异性、灵敏度、可重复性、仪器适用性,并将其与常用检测试剂盒进行比对。结果本研究成功构建多重荧光RT-PCR检测体系,能同时检出甲型H1N1、季节性H1N1及H3N2亚型流感病毒,检测灵敏度为101~102拷贝/μl,可重复性好(变异系数为0.47%~4.03%),比常用检测试剂具有更好的荧光值水平,可适用于多种常见的荧光定量PCR仪。结论本方法所构建检测流感亚型体系具有较好的特异性、灵敏度、可重复性、仪器适用性,适用于各基层疾控及医疗机构。     

Sixty-two severe and critical patients with 2009 influenza A (H1N1) in Shanghai, China

Background Pandemic influenza A (H1N1) emerged rapidly in China in May 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A (H1N1) disproportionately affects younger ages and causes generally mild disease. To characterize disease progress, comorbidities, and treatment outcomes among consecutive severe and critically ill patients in a hospital served as a reference center for the care of patients with H1N1 in Shanghai,China.Methods A retrospective study on 62 severe and critically ill patients with 2009 influenza A (H1N1) was conducted in Shanghai Public Health Clinical Center. Demographic data, symptoms, comorbidities, disease progression, treatments,and clinical outcomes were collected for analysis.Results Sixty-two severe or critically ill patients were admitted to the hospital with confirmed 2009 influenza A (H1N1) infection. The median age of the study cohort was 40 years old with a range from 18 years to 75 years, and 67.7% were males. All patients presented with fever and respiratory symptoms. At presentation, 34 patients (54.8%) had comorbidities such as smoking (29.0%), hypertension (29.0%) and hepatitis B virus infection (9.7%). The median time from symptom onset to hospital admission was 6 days (interquartile-range 3-14 days) and 23 critically ill patients were admitted to Intensive Care Unit after admission. All the patients received neuraminidase inhibitors (oseltaminir), while 60 patients (96.7%) were treated with antibiotics, and 39 (62.9%) with corticosteroids. Twenty-three critical cases received noninvasive mechanical ventilation on the first day of admission, and 3 of them ultimately required invasive ventilation.Four death reports (6.5%) were filed within the first 14 days from the onset of critical illness with the primary causes of severe acute respiratory distress syndrome, hypoxemia, or complications, secondary infection and sepsis,pyopneumothorax and stroke.Conclusions Severe illness from 2009 influenza A (H1N1) infection in Shanghai occurred among young individuals. Critical cases were associated with severe hypoxemia, multisystem organ failure, and a requirement for mechanical ventilation. Most patients had a good prognosis.     

南通市人群甲型H1N1流感流行监测与分析

目的:了解南通市人群甲型H1N1流感流行规律,为疫情防控提供科学依据。方法:采用荧光定量RT-PCR对哨点医院采集的咽拭子进行甲型H1N1流感病毒的RNA检测,应用统计软件分析流行状况。结果:咽拭子2646份标本中,男性1377份,女性1269份。甲型H1N1标本阳性679份(25.66%)中,男性感染337例(24.47%);女性感染342例(26.95%);感染率性别间差异无统计学意义(P>0.05)。学生1582例感染病例435例(27.50%),其他职业1064例感染244例(22.93%),学生感染率显著高于其他人群(P<0.05)。15～岁250例中感染154例(61.60%),明显高于其他各年龄组(P<0.01)。2009年底疫情达到高峰,分别为11月检测306例,感染155例(50.65%),12月检测371例,感染212例(57.14%)。结论:2009年南通市甲型H1N1流感暴发相对较温和,目前已呈消退趋势,但是否会再次出现甲型流感的大范围暴发值得警惕。     

Influenza A pandemic (H1N1) 2009 virus infection

The clinical spectrum of the 2009 pandemic influenza A (H1N1) infection ranged from self-limited mild illness to progressive pneumonia, or even a fatal outcome. We summarize the clinical manifestations, risk factors for severe and fatal cases, pathologic findings and treatment of this disease in this paper based on current reports from different regions of the world.

     

重症甲型H1N1流感患者外周血T淋巴细胞亚群变化的临床意义探讨

目的 探讨甲型H1N1流感(甲流)患者外周血T淋巴细胞亚群的变化及临床意义.方法 采用流式细胞仪对70例甲流患者,19例普通流感患者,31例健康体检者的外周血T淋巴细胞亚群进行检测.70例甲流患者中,男51例,女19例,年龄19～66岁.其中重症24例,危重症46例(死亡8例).结果 普通流感患者外周血T淋巴细胞亚群与...     

甲型H1N1流行性感冒210例流行病学调查分析

目的了解青岛地区新型甲型H1N1流行性感冒的流行病学和临床特征,提高临床医师对该病的认识。方法采取描述性流行病学方法对青岛市海慈医疗集团2009年10月10日～2010年1月10日确诊的210例甲型H1N1流感患者资料进行回顾性分析。结果该组患者男136例,女74例,年龄12～83岁,平均年龄34岁;发病高峰期为2009年11月和12月;临床主要表现为流感样症状,包括发热、咽痛、咳嗽,其他症状有咳痰、流涕、鼻塞、头痛和全身酸痛等,体征有咽部充血、扁桃体肿大等;90%患者外周血WBC总数正常或偏低;48%患者CD+4T淋巴细胞低于正常下限水平。甲型H1N1流感感染者的咽拭子标本在发热时检测为阳性;该病预后良好,所有患者均治愈出院。结论甲型H1N1流感病情温和,其流行病学和临床表现与普通季节性流感类似。     

A(H1N1)甲型流感病毒基因多态性对病毒复制及毒力的影响研究

目的研究A(H1N1)甲型流感病毒基因多态性对病毒复制及毒力的影响。方法选择A/Californ ia/04/2009,A/S ichuan/1/2009和A/Be ijing/3/2009 3株病毒,分别感染MDCK细胞,测定病毒RNA载量和病毒效价;同时滴鼻接种BALB/c小鼠,检测小鼠感染后的多项指标,观察期为14天。另一方面,对3株病毒的全基因组进行测序及序列比对,对其基因突变情况及多态性进行分析。结果 A/S ichuan/1/2009株相较而言具有较高的复制能力及毒力,序列分析结果显示全基因中有5个氨基酸发生了突变,其中PA蛋白中343位点的A突变为T,PB1蛋白中353位点的K突变为R,566位点的T突变为A,PB2蛋白中471位点的T突变为M,对病毒毒力的增强起重要作用。结论 A(H1N1)甲型流感病毒基因组多态性与其复制及毒力密切相关。     

甲型H1N1流感病例513例分析

目的对比分析甲型H1N1流感、季节性流感、普通感冒的临床症状、体征及病程。方法对比分析2009年5-10月来我科就诊并确诊为甲型H1N1流感患者513例（A组）、季节性流感患者242例（B组）、普通感冒患者1200例（C组）的临床资料。结果A、B组患者头痛、咽痛、咳嗽、胃肠症状、全身酸痛、关节痛等症状发生率,最高体温、发热天数、肺部哆音和腹部压痛等体征发生率以及血常规检验中淋巴细胞百分比、单核细胞百分比均明显高于C组,血小板计数明显低于C组,差异均有统计学意义（P〈0．05）;A组患者头痛、咳嗽、胃肠症状等的发生率,扁桃体肿大、肺部哆音、腹部压痛等体征发生率,以及血常规检验中淋巴细胞百分比、单核细胞百分比等均高于B组（P〈0．05）。结论甲型H1N1流感患者症状、体征、病程及血常规检查均较普通感冒重,类似于季节性流感,但二者在某些症状和实验室指标方面有明显差别。     

甲型H1N1流感非干预及应用奥司他韦治疗对照研究

目的研究甲型H1N1流感患者在非干预自然状态下的病情演变过程及预后,并与应用奥司他韦（达菲）治疗患者进行对照研究。方法对93例甲型H1N1流感确诊患者进行前瞻性临床观察,将入院时发病时间〉48h的51例患者纳入不应用奥司他韦治疗的非干预组,将发病时间≤48h者的42例患者纳入奥司他韦组,比较两组患者的临床特征、症状持续时间、病毒转阴时间以及奥司他韦对患者病程的影响。结果两组患者临床表现较季节性流感轻,生化检查基本正常。非干预组发热持续时间为（4.16±3.04）d,病毒核酸转阴时间为（5.79±1.91）d;奥司他韦组发热持续时间为（2.53±1.46）d,病毒核酸转阴时间为（4.91±1.44）d;两组比较有显著性差异。结论甲型H1N1流感患者病情表现较为温和,流感样症状轻,轻症患者可呈自限性经过,可不予奥司他韦治疗,但隔离时间应适当延长至病后7d。     

Gene expression profiles comparison between 2009 pandemic and seasonal H1N1 influenza viruses in A549 cells

Objective To perform gene expression profiles comparison so that to identify and understand the potential differences in pathogenesis between the pandemic and seasonal A （H1N1） influenza viruses. Methods A549 cells were infected with A/California/07/09 （H1N1） and A/GuangdongBaoan/51/08 （H1N1） respectively at the same MOI of 2 and collected at 2, 4, 8, and 24 h post infection （p.i.）. Gene expression profiles of A549 cells were obtained using the 22 K Human Genome Oligo Array, and differentially expressed genes were analyzed at selected time points. Results Microarrays results indicated that both of the viruses suppressed host immune response related pathways including cytokine production while pandemic H1N1 virus displayed weaker suppression of host immune response than seasonal H1N1 virus. Observation on similar anti-apoptotic events such as activation of apoptosis inhibitor and down-regulation of key genes of apoptosis pathways in both infections showed that activities of promoting apoptosis were different in later stage of infection. Conclusion The immuno-suppression and anti-apoptosis events of pandemic H1N1 virus were similar to those seen by seasonal H1N1 virus. The pandemic H1N1 virus had an ability to inhibit biological pathways associated with cytokine responses, NK activation and macrophage recognition .     

海南省5例危重症甲型H1N1流感病例分析

目的分析5例危重症甲型H1N1流感患者的临床特征,总结和探讨其治疗方法。方法回顾性分析我院收治5例危重症甲型H1N1流感患者的临床资料。结果5例患者均有发热、鼻塞、咽痛、咳嗽、咳痰,出现血小板异常,胸部影像学显示双肺渗出性改变,并先后出现呼吸衰竭。4例有心肌酶升高。3例痰培养有细菌生长。5例均予奥司他韦抗病毒,抗感染和机械辅助通气、营养支持及对症等综合治疗。2例痊愈出院,3例好转。结论危重症甲型H1NI流感患者常合并肺部细菌感染和呼吸衰竭,易出现血小板异常和多脏器损伤。奥司他韦抗病毒、抗感染、机械辅助通气等综合治疗是抢救危重症甲型H1N1流感患者的重要手段。     

江阴市2009年甲型H1N1流感疫情分析

目的探讨江阴市甲型H1N1流感流行特征并提出防治措施。方法对江阴市2009年甲型H1Nl流感疫情资料进行分析。结果 2009年累计确诊甲型H1N1流感病人22例,其中重症病例3例、危重2例、死亡1例,发病率为1.25/10万。发生2起暴发疫情,均发生在学校。检测流感样病人咽拭子标本124份,甲型H1N1流感核酸阳性率为11.29%。结论江阴市采取的一系列甲型H1Nl流感防控措施整体上显著有效,2009年江阴市甲型H1N1流感疫情处于低流行水平。     

60例甲型H1N1流感病例临床分析

目的：分析甲型H1N1流感病例的临床特点。方法：回顾性分析2009年8月至2010年3月我院发热门诊确诊的甲型H1N1流感病例60例。结果：60例病人中,男34例,女26例,年龄最小8岁,最大47岁,发病中位年龄22岁,学生42例,占70%。主要临床表现为发热、咽痛、咳嗽、肌肉酸痛。白细胞正常或低下者48例,白细胞增高者12例,所有病例均无肺炎等并发症。予莲花清瘟胶囊或炎琥宁针剂治疗,平均4d热退（2-8d）,咳嗽、咽痛、肌肉酸痛减轻。结论：甲型H1N1流感临床表现与季节性流感相似,诊断主要依靠鼻、咽拭子病毒核酸检测。本院60例病例均为轻症,以学生为主,未发生并发症预后良好。     

Influenza A (H1N1) pneumonia: an analysis of 63 cases by chest CT

Background  In early April 2009, cases of human infection with 2009 pandemic influenza A (H1N1) virus were identified in Mexico. The virus then spread rapidly to other regions of the world. From October 2009, sporadic imported cases of novel influenza A (H1N1) were continuously confirmed in Suzhou. The aim of the study was to review the chest CT findings in 63 patients with laboratory-confirmed novel swine-origin influenza A (H1N1) virus (S-OIV) infection.

Methods  Chest CT examinations were collected from 63 S-OIV infected patients during their hospital stay. Three experienced radiologists inspected images to qualitatively and quantitatively characterize S-OIV induced image changes. CT scores of lesion severity were calculated based on the percentage of affected area to determine severity of infectious lesions. Patients were divided into two groups based on the leukocyte counts. Lesion patterns, local distributions, and quantitative measures were investigated and compared between the two groups.

Results  Various degrees of bilateral multifocal lesions of ground-glass opacities were found with or without consolidations on the chest CT images. The lesions were both bronchocentric and centrilobular. Patients with elevated leukocyte counts had more extensive lesions, in terms of severity and affected area, than the patients with normal leukocyte counts. The lesion severity scores of patients in the elevated leukocyte group were significantly higher than those of the normal leukocyte group in terms of the entire lung area (P <0.01), and upper (P <0.05) and lower (P <0.01) lobes as well. There were changes in the CT characteristics seen at follow-up as demonstrated by lesions absorption (P <0.01), especially in the upper lobe of the lung (P <0.01), but less so in the middle lobe/lingual and lower lobe of the lung (P >0.05).

Conclusions  The most common CT findings in S-OIV infection patients were bilateral multifocal distributed ground-glass opacities and consolidations. The lesions were located dominantly at bronchocentric and centrilobular areas. Lung lesions were more obviously absorbed in upper lobes between two examinations. The observations and analysis from this study provide information that may be useful in image understanding and patient management for future pandemic influenza.