科学应对甲型H1N1流感

甲型H1N1病毒在世界范围内的广泛流行引起了WHO的高度重视,疫情警告级别一度从3级提高到4级,又提高到5级.本文从流感病毒的发现、历史上流感大流行的有关情况出发,介绍此次甲型H1N1流感疫情的科学应对方法 ,包括甲型H1N1病毒的传播及甲型H1N1流感的临床表现、治疗、主要防控措施等.     

甲型H1N1流感胸部影像学表现

甲型H1N1流感是2009年在全球爆发流行的呼吸道传染病.引起胸部异常者少见但病人症状较重.主要胸部影像学表现为肺内磨玻璃影和实变影.胸部X线摄影和CT是常用检查手段.就2009年H1N1流感的胸部影像学表现进行综述.     

甲型H1N1流感病毒隐性感染者1例

甲型H1N1流感自今年3月暴发以来,虽然各国政府始终在积极采取各种防控措施,但疫情仍在不断蔓延和扩大.WHO报告,截至2009年7月5日,此起流感疫情已波及全球五大洲的126个国家和地区,确诊病例达89 922例,死亡382人.我周内地也有24个省份累计报告确诊病例1 040例,包括输入性病例758例,本土病例282例.     

军人甲型H1N1流感273例临床特点分析

自2009年5月10日我国发现首例输入性甲型H1N1流感病例以来,疫情随之在我国逐渐蔓延。2009年8-12月,我们共收治军人甲型H1N1流感273例。现将其临床特点分析报告如下。     

甲型H1N1流感病毒性肺炎的影像学表现

目的:回顾性讨论12例甲型H1N1流感病毒性肺炎患者的胸部X线和CT表现特征。方法:经临床证实的甲型H1N1流感病毒性肺炎病例12例,男8例,女4例,年龄范围6~51岁,平均年龄21岁。所有患者在发病后1周内均行胸部X线检查及胸部CT扫描。结果:本组病例中,出现临床症状1~4天胸片像表现为阳性者10例,占83%;4~8天胸片像上为阳性者2例,占17%。多数患者的病灶多发。进展期病变发展迅速,常累及多部位及双肺。好转期一般在7~14天。结论:甲型H1N1流感病毒性肺炎主要影像学表现为:①病变位于肺的外周多,多部位受累,双肺各叶均可发生,以双肺下叶为著;②病变多发,大小不等;③早期最常见的影像学表现为斑片状磨玻璃影;④病变变化迅速。     

甲型H1N1流感肺炎的影像学表现

甲型H1N1流感是新发呼吸道传染病,肺炎是其主要并发症.本文介绍了甲型H1N1流感肺炎的病理、临床、影像检查策略、影像学表现和演变以及鉴别诊断.     

某干休所防控甲型H1N1流感的做法

2009年11月,我所出现了1例甲型H1N1流感（甲流）确诊病例,经过全所人员的共同努力,未造成疫情扩散。现将我们在此次防控工作中的做法及体会报告如下。     

甲型H1N1流感胸部薄层CT的诊断价值及限度

目的：分析甲型H1N1流感（S-OIV）动态胸部CT征象,探讨薄层CT在临床诊断中的价值。方法：回顾性分析经临床和实验室检查确诊的56例甲型H1N1流感患者的胸部CT的完整影像资料,分别由两位从事胸部CT诊断医师评估胸部常规CT表现,包括病变形态、密度、分布范围等特点,并与薄层CT扫描比较其影像表现的动态变化,确定诊断意见。结果：56例甲型H1N1患者中,薄层CT与常规CT扫描均有异常所见,薄层CT对病灶细节的显示优于常规CT检查。本组病例早期表现为磨玻璃密度影35例,病变进展期在磨玻璃影内出现类圆形或多发小片状实变24例,直接表现为肺叶或肺段的大片状炎性实变者13例,出现肺不张3例,肺间质增生2例,胸膜病变41例。本组CT动态变化特点是早期小片状渗出的磨玻璃状改变,进展期向大片状磨玻璃密度影和多发片状实变影过渡,最后常见有肺内病变范围减少,密度不均和肺间质性改变。结论：薄层CT可为鉴别具有甲型H1N1流感典型表现的患者与其它类型肺炎患者提供重要信息。薄层CT能反映甲型H1N1患者肺部病变的密度、形态和范围及其动态变化,对S-OIV的早期诊断和了解病变的全部影像动态变化过程具有较重要的意义,并可为临床诊疗提供可靠信息。     

某军队院校防控甲型H1N1流感的做法

自2009年．4月墨西哥确诊首例甲型H1N1流感（以下简称甲流）病例以来,疫情在全球迅速扩散蔓延。国内有专家预测,本次甲流疫情可能持续1～2年,而且可能第1波症状较轻,第2波才出现较多重症病例;聚集性发生和社区暴发流行可能是未来的主要传播模式;随着病例基数的增加,也可能出现死亡病例。如此严峻的疫情形势给军队院校甲流防控带来了新的挑战。为保证全院人员的身体健康和正常的工作及生活秩序,依据上级的防控策略和要求,结合我院人员成分复杂、对外交往较多、人员流动性大、学员及勤务人员集中生活等实际情况,我们借鉴运用抗击“非典”的成功经验及做法,狠抓了甲流防控工作的贯彻落实。现将主要做法报告如下。     

A microcosting study of diagnostic tests for the detection of coronary artery disease in The Netherlands

Objective

The primary aim of the present study was to calculate the actual costs of four diagnostic tests for the detection of coronary artery disease in the Netherlands using a microcosting methodology. As a secondary objective, the cost effectiveness of eight diagnostic strategies was examined, using microcosting and reimbursement fees subsequently as the cost estimate.

Design

A multicenter, retrospective cost analysis from a hospital perspective.

Setting

The study was conducted in three general hospitals in the Netherlands for 2006.

Interventions

Exercise electrocardiography (exECG), stress echocardiography (sECHO), single-photon emission computed tomography (SPECT) and coronary angiography (CA).

Results

The actual costs of exECG, sECHO, SPECT and CA were €33, 216, 614 and 1300 respectively. For all diagnostic tests, labour and indirect cost components (overheads and capital) together accounted for over 75% of the total costs. Consumables played a relatively important role in SPECT (14%). Hotel and nutrition were only applicable to SPECT and CA. Diagnostic services were solely performed for CA, but their costs were negligible (2%). Using microcosting estimates, exECG-sECHO-SPECT-CA was the most and CA the least cost effective strategy (€397 and 1302 per accurately diagnosed patient). Using reimbursement fees, exECG-sECHO-CA was most and SPECT-CA least cost effective (€147 and 567 per accurately diagnosed patient).

Conclusions

The use of microcosting estimates instead of reimbursement fees led to different conclusions regarding the relative cost effectiveness of alternative strategies.     

Value of diagnostic tests for deep venous thrombosis: a decision analysis model

A decision analysis model and data pooled from more than 12,000 patients were used to help elucidate conflicting results about the preferred method for diagnosing deep venous thrombosis (DVT). The prevalence of DVT in symptomatic legs is 40%, a value at which venography followed by Doppler ultrasound (in cases of nondiagnostic or unsuccessful venography) is preferred over the sequence of Doppler-plethysmography, provided that the sensitivity of the latter is less than 94%. If the prevalence of DVT decreases to 25% or the sensitivity of Doppler is 95% or higher, then the sequences of Doppler-plethysmography and venography-Doppler are equivalent in helping minimize resulting morbidity and mortality. Because of the greater clinical significance of proximal DVT, the analysis was modified to reflect changes in prevalence, sensitivity of noninvasive tests, and rate of pulmonary embolus due to DVT extending above the knee. In this case, performing plethysmography is slightly better than performing venography followed by Doppler or plethysmography.     

聚合酶螺旋反应快速检测甲型H1N1流感病毒

目的 建立利用聚合酶螺旋反应(PSR)快速检测甲型H1N1流感病毒的方法.方法 针对甲型H1N1流感病毒的特异性HA基因设计了6套引物,通过实时浊度法和显色法两种方法判断结果.结果与结论 从6套引物中筛选出了最佳引物,并确定最佳温度为65℃;进一步实验表明最佳引物能特异性地检测H1N1病毒,与14种其他呼吸道病原核酸无交叉反应,敏感性达到100拷贝,与PCR敏感性一致.所建立的方法简单快速、特异性强、敏感性高,适合现场和基层单位应用推广.     

Quantifying the value of diagnostic tests

This paper considers the different statistics that can be derived from studies on the value of diagnostic tests. Well-accepted quantities, such as sensitivity and specificity, are reviewed and the value of the likelihood ratio in communicating particular test results is highlighted. A new quantity, the 'diagnostic value index', is proposed and various examples of its application in nuclear medicine studies are presented. This new index is based on a weighted average of the likelihood ratios for all possible outcomes of the test, the average being weighted according to how frequently a particular outcome occurs. This index provides an objective and quantitative means of comparing the diagnostic value of different tests, or of comparing the value of a given test in different patient groups. It is hoped that this will be a useful aid to clinical decision-making concerning referrals for diagnostic tests.