中国高致病性禽流感A/H5N1病毒感染患者的临床与预后

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.

Relationship between clinical features and prognosis of highly pathogenic avian influenza A/H5N1 infection in humans in mainland China

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.