95例甲型H1N1流感患者危险因子及临床治疗分析

Objective To explore the curative effect of antivirus drugs to the patients with different degree A(H1N1) influenza, and to summarize the reasonable treatment protocols. Methods The clinical data of 95 adult patients with A( H1N1) influenza from June 2009 to February 2010 were collected and analyzed retrospectively. The differences in mild, severe and critical patients in physical status, hospital days, temperature peak, persistent fever period, oseltamivir treatment, other antiviral drugs and combined therapy were compared. Results There were statistical differences in risk factor (5.3%, 18.2%,66.1%, P<0.05), persistent fever period (2.2 days,5.6 days, 9.4 days, P<0.01), courses of treatment of oseltamivir were (4.1 ±0.4) days, (6.3 ±0.5) days, (9.2±1.8) days respectively ( P < 0.05). There were statistical differences among critical patients and mild, severe patients in mean onset days of oseltamivir oral(P<0.01). Cleaning time of virus in critical cases was longer than others cases. Comprehensive therapy included mechanical ventilation, antibiotics, corticoeteroid and blood plasma was necessary in severe patients. Conclusions The patients with critical high risks, especially with respiratory diseases or endocrine diseases, would progress to severe condition. The longer the fever, the easier to progress to severe condition. Oseltamivir is safe and effective, it is important to use it as early as possible. Oseltamivir should be used longer on the patients with severe condition, especially with respiratory disease. The comprehensive therapy is extremely important to severe patients.     

11例甲型H1N1流感孕产妇的临床分析

Objective To study the clinical characteristics and therapeutic effect of pregnant women infected with severe influenza A(H1N1), to survey the disease effects for the newborns. Methods The clinical data of 11 pregnant women infected with influenza A(H1N1 ) in our hospital from November to December 2009 were analyzed retrospectively. Results All the cases were in serious conditions, and 3 cases were in critical. All the patients were with symptoms of fever and cough, the temperature were in 38.7-39.6 ℃, and duration were 3-14 days. There were 9 cases with low lymphocytes, and 9 cases with high WBC. CRP were elevated in all the cases ( 12-129 mg/L), 9 cases were with hypochromia (22.4-30.2 mg/L). X ray showed increases of pulmonary hilar density for all the cases. By comprehensive treatment, 10 patients were cured and one showed marked progress. 9 cases continued pregnacy. One infant with septicemia was cured, other newborns and fetus were in good condition. Conclusions Pregnant women infected with influenza A (H1N1) are likely to develop severe condition. It is important to use antiviral treatment promptly,supplementary comprehensive treatment. Continuing pregnancy is safe, but the outcome to newborn needs further study.     

江苏省苏州市2009--2010年甲型H1N1流感住院病例抗病毒药物使用情况调查

目的 了解甲型H1N1流感大流行期间流感住院病例抗病毒药物使用情况及存在的问题.方法 选择苏州市3家市级医院.查看2009年6月至2010年3月甲型H1N1流感大流行期间住院治疗的甲型H1N1流感病例的病历资料,了解抗病毒药物的使用情况及有关信息.结果 98%(222/226)的甲型H1N1流感住院病例在住院期间使用过抗病毒药物,其中92%(205/222)使用过神经氨酸酶抑制剂--奥司他韦,但仅18%是在发病后2 d内开始用药.未发现医院对住院甲型H1N1流感病例使用金刚烷胺、金刚乙胺等抗病毒药物.对医生进行访谈发现,就诊延迟、医生误诊、等待实验室检测与结果 反馈等因素影响奥司他韦的及时使用.结论 在甲型H1N1流感大流行期间,苏州市3家市级医院绝大多数住院病例使用了奥司他韦,但药物使用及时性差.需要开发甲型H1N1流感病毒的快速检测技术,提高医生的诊断水平,以缩短病例诊断时间,提高用药的时效性,改善这类抗病毒药物的使用效果.

Abstract：

Objective To explore the use of antiviral drugs in treating the hospitalized patients of novel influence A(H1N1)in Suzhou city during the 2009-2010 influenza pandemic,so as to make the proper use of antiviral drugs during influenza epidemics.Methods We selected 3municipal hospitals and reviewed the medieal records of hospimlized patients suffered from novel influence A(H1N1)during June 2009 to March 2010,to gather antiviral use and other related information.Results 98%(222/226)of the hospitalized patients received antiviral treatment.Among them,92%(205/222)were given the neuraminidase inhibitor oseitamivir.However,only 18% of the patients who received oseltamivir were given the treatment within 2 days after the onset of the illness.Amantadine and rimantadinc were not used for any of the hospitalized patients.Through interview on the physicians,we identified that delay in seeing care,misdiagnosis,delay in laboratory diagnosis were factors affecting the timely use of oseltamivir.Conclusion The majority of the hospitalized patients suffered from novel influence A(H1N1)in the three municipal hospitals received oseltamivir treatment.However,in most occasions the drug was not used timely.Techniques of rapid detection and diagnosis for novel influenza A(H1N1)virus should be developed,and the diagnostic capabilities of the physicians improved,to increase the effectiveness of these antiviral drugs.     

甲型H1N1流感病毒基因组序列分析及其特性研究

Objective To analyse the genome of influenza A (H1N1) vires so as to elucidate its molecular characteristics and evolution status. Methods DNA sequences of the influenza viruses were collected from NCBI, and compared with the genomes of referenced intluenza viruses. The phylogenetic trees were constructed by the neighbor-joining method, and the pathogenicity, drug susceptibility and vaccine protection were analyzed. Results Phyiogenetic analysis showed that the genes encoding HA, PB2, PBI, PA, NP, and NS protein were most closely related to those influenza A viruses circulating in swine populations in North America. NA and M gene belonged to Eurasia lineages swine influenza vires. The amino acid sequence of the cleavage site between HA1 and HA2 was PARSSR ↓ GLFGAI with the typical characteristics of the low pathogenic influenza virus. Influenza A(H1N1) virus can spread from person-to-person. It is sensitive to oseltamivir and zanamivir but resistant to amantadine and remantadine. The current human seasonal influenzavaccines confered little protection against influenza A/H1N1 because of the great diversity on antigenic domains between A/H1N1 virus and vaccine virus. Conclusions Influenza A(H1N1) virus is a reassortant virus of North America and Eurasia hneages swine influenza virus. It is important to develop a vaccine against the currently circulating virus strain to control the disease spread.     

甲型H1N1流感病毒基因组序列分析及其特性研究

Objective To analyse the genome of influenza A (H1N1) vires so as to elucidate its molecular characteristics and evolution status. Methods DNA sequences of the influenza viruses were collected from NCBI, and compared with the genomes of referenced intluenza viruses. The phylogenetic trees were constructed by the neighbor-joining method, and the pathogenicity, drug susceptibility and vaccine protection were analyzed. Results Phyiogenetic analysis showed that the genes encoding HA, PB2, PBI, PA, NP, and NS protein were most closely related to those influenza A viruses circulating in swine populations in North America. NA and M gene belonged to Eurasia lineages swine influenza vires. The amino acid sequence of the cleavage site between HA1 and HA2 was PARSSR ↓ GLFGAI with the typical characteristics of the low pathogenic influenza virus. Influenza A(H1N1) virus can spread from person-to-person. It is sensitive to oseltamivir and zanamivir but resistant to amantadine and remantadine. The current human seasonal influenzavaccines confered little protection against influenza A/H1N1 because of the great diversity on antigenic domains between A/H1N1 virus and vaccine virus. Conclusions Influenza A(H1N1) virus is a reassortant virus of North America and Eurasia hneages swine influenza virus. It is important to develop a vaccine against the currently circulating virus strain to control the disease spread.     

甲型H1N1流感病毒基因组序列分析及其特性研究

Objective To analyse the genome of influenza A (H1N1) vires so as to elucidate its molecular characteristics and evolution status. Methods DNA sequences of the influenza viruses were collected from NCBI, and compared with the genomes of referenced intluenza viruses. The phylogenetic trees were constructed by the neighbor-joining method, and the pathogenicity, drug susceptibility and vaccine protection were analyzed. Results Phyiogenetic analysis showed that the genes encoding HA, PB2, PBI, PA, NP, and NS protein were most closely related to those influenza A viruses circulating in swine populations in North America. NA and M gene belonged to Eurasia lineages swine influenza vires. The amino acid sequence of the cleavage site between HA1 and HA2 was PARSSR ↓ GLFGAI with the typical characteristics of the low pathogenic influenza virus. Influenza A(H1N1) virus can spread from person-to-person. It is sensitive to oseltamivir and zanamivir but resistant to amantadine and remantadine. The current human seasonal influenzavaccines confered little protection against influenza A/H1N1 because of the great diversity on antigenic domains between A/H1N1 virus and vaccine virus. Conclusions Influenza A(H1N1) virus is a reassortant virus of North America and Eurasia hneages swine influenza virus. It is important to develop a vaccine against the currently circulating virus strain to control the disease spread.     

甲型H1N1流感病毒基因组序列分析及其特性研究

Objective To analyse the genome of influenza A (H1N1) vires so as to elucidate its molecular characteristics and evolution status. Methods DNA sequences of the influenza viruses were collected from NCBI, and compared with the genomes of referenced intluenza viruses. The phylogenetic trees were constructed by the neighbor-joining method, and the pathogenicity, drug susceptibility and vaccine protection were analyzed. Results Phyiogenetic analysis showed that the genes encoding HA, PB2, PBI, PA, NP, and NS protein were most closely related to those influenza A viruses circulating in swine populations in North America. NA and M gene belonged to Eurasia lineages swine influenza vires. The amino acid sequence of the cleavage site between HA1 and HA2 was PARSSR ↓ GLFGAI with the typical characteristics of the low pathogenic influenza virus. Influenza A(H1N1) virus can spread from person-to-person. It is sensitive to oseltamivir and zanamivir but resistant to amantadine and remantadine. The current human seasonal influenzavaccines confered little protection against influenza A/H1N1 because of the great diversity on antigenic domains between A/H1N1 virus and vaccine virus. Conclusions Influenza A(H1N1) virus is a reassortant virus of North America and Eurasia hneages swine influenza virus. It is important to develop a vaccine against the currently circulating virus strain to control the disease spread.     

甲型H1N1流感病毒基因组序列分析及其特性研究

Objective To analyse the genome of influenza A (H1N1) vires so as to elucidate its molecular characteristics and evolution status. Methods DNA sequences of the influenza viruses were collected from NCBI, and compared with the genomes of referenced intluenza viruses. The phylogenetic trees were constructed by the neighbor-joining method, and the pathogenicity, drug susceptibility and vaccine protection were analyzed. Results Phyiogenetic analysis showed that the genes encoding HA, PB2, PBI, PA, NP, and NS protein were most closely related to those influenza A viruses circulating in swine populations in North America. NA and M gene belonged to Eurasia lineages swine influenza vires. The amino acid sequence of the cleavage site between HA1 and HA2 was PARSSR ↓ GLFGAI with the typical characteristics of the low pathogenic influenza virus. Influenza A(H1N1) virus can spread from person-to-person. It is sensitive to oseltamivir and zanamivir but resistant to amantadine and remantadine. The current human seasonal influenzavaccines confered little protection against influenza A/H1N1 because of the great diversity on antigenic domains between A/H1N1 virus and vaccine virus. Conclusions Influenza A(H1N1) virus is a reassortant virus of North America and Eurasia hneages swine influenza virus. It is important to develop a vaccine against the currently circulating virus strain to control the disease spread.     

甲型H1N1流感病毒基因组序列分析及其特性研究

Objective To analyse the genome of influenza A (H1N1) vires so as to elucidate its molecular characteristics and evolution status. Methods DNA sequences of the influenza viruses were collected from NCBI, and compared with the genomes of referenced intluenza viruses. The phylogenetic trees were constructed by the neighbor-joining method, and the pathogenicity, drug susceptibility and vaccine protection were analyzed. Results Phyiogenetic analysis showed that the genes encoding HA, PB2, PBI, PA, NP, and NS protein were most closely related to those influenza A viruses circulating in swine populations in North America. NA and M gene belonged to Eurasia lineages swine influenza vires. The amino acid sequence of the cleavage site between HA1 and HA2 was PARSSR ↓ GLFGAI with the typical characteristics of the low pathogenic influenza virus. Influenza A(H1N1) virus can spread from person-to-person. It is sensitive to oseltamivir and zanamivir but resistant to amantadine and remantadine. The current human seasonal influenzavaccines confered little protection against influenza A/H1N1 because of the great diversity on antigenic domains between A/H1N1 virus and vaccine virus. Conclusions Influenza A(H1N1) virus is a reassortant virus of North America and Eurasia hneages swine influenza virus. It is important to develop a vaccine against the currently circulating virus strain to control the disease spread.     

甲型H1N1流感病毒基因组序列分析及其特性研究

Objective To analyse the genome of influenza A (H1N1) vires so as to elucidate its molecular characteristics and evolution status. Methods DNA sequences of the influenza viruses were collected from NCBI, and compared with the genomes of referenced intluenza viruses. The phylogenetic trees were constructed by the neighbor-joining method, and the pathogenicity, drug susceptibility and vaccine protection were analyzed. Results Phyiogenetic analysis showed that the genes encoding HA, PB2, PBI, PA, NP, and NS protein were most closely related to those influenza A viruses circulating in swine populations in North America. NA and M gene belonged to Eurasia lineages swine influenza vires. The amino acid sequence of the cleavage site between HA1 and HA2 was PARSSR ↓ GLFGAI with the typical characteristics of the low pathogenic influenza virus. Influenza A(H1N1) virus can spread from person-to-person. It is sensitive to oseltamivir and zanamivir but resistant to amantadine and remantadine. The current human seasonal influenzavaccines confered little protection against influenza A/H1N1 because of the great diversity on antigenic domains between A/H1N1 virus and vaccine virus. Conclusions Influenza A(H1N1) virus is a reassortant virus of North America and Eurasia hneages swine influenza virus. It is important to develop a vaccine against the currently circulating virus strain to control the disease spread.     

CYP1A1、GSTT1、GSTM1基因与乳腺癌易感性的病例对照研究

目的探讨雌激素代谢通路相关基因CYP1A1、GSTT1、GSTM1与乳腺癌易感性的关系。方法采用聚合酶链反应(PCR)、限制性片段长度多态性(RFLP)及琼脂糖凝胶电泳法,对天津市360例正常女性和315例女性乳腺癌患者的CYP1A1、GSTT1、GSTM1基因及多态性进行检测,Logistic回归分析评估单基因、联合基因以及相关因素对乳腺癌的危险度。结果 CYP1A1基因、GSTT1基因、GSTM1基因在两组间分布频率有差异(χ2值分别为20.677,47.250,43.621,P=0.000)。基因型联合分析显示,随着携带危险基因型数目的增加,个体罹患乳腺癌的危险性增加(χ2=51.366,P=0.000)。多因素非条件Logistic回归分析结果显示,CYP1A1基因与体育锻炼、摄入肉类(每日多于150g)、摄入蔬菜(每日超过300g)的交互作用有统计学意义[OR(95%CI)分别为0.465(0.362～0.597)、1.559(1.344～1.808)、0.465(0.362～0.597)];GSTT1基因缺失、GSTM1基因缺失是乳腺癌的危险因素[OR(95%CI)分别为3.245(1.645～6.375)、2.462(1.818～3.334)],且GSTT1基因与体育锻炼、累计行经年数的交互作用有统计学意义[OR(95%CI)分别为1.546(1.113～2.147)、3.735(1.401～9.956)],GSTM1基因与哺乳期限、绝育手术的交互作用有统计学意义[OR(95%CI)分别为1.206(1.024～1.420)、1.690(1.353～2.111)]。结论雌激素代谢通路相关基因与乳腺癌发生有关,且其与雌激素暴露影响因素、生活方式等存在交互作用。     

母亲和新生儿GSTM1、GSTT1和细胞色素P_(450)1A1基因多态性与早产易感性关系

目的探讨母亲和新生儿GSTM1、GSTT1基因以及细胞色素P4501A1基因多态性对早产的影响。方法采用病例-对照调查方法,应用多重PCR和限制性内切酶PCR(RFLP-PCR)技术对早产母亲和对照母亲以及早产新生儿和对照新生儿GSTM1、GSTT1基因和CYP1A1基因MSPI位点多态性分别进行检测。结果GSTM1、GSTT1基因和CYP1A1基因MSPI位点多态性在早产母亲和对照母亲组中没有显著性差异(P>0.05);以上基因在早产新生儿和对照新生儿组中也没有显著性差异(P>0.05)。GSTM1与GSTT1联合基因型在母亲和新生儿的病例与对照组中也没有显著性差异(P>0.05);GSTT1缺失型和CYP1A1变异型联合基因在早产母亲组与对照母亲组中有显著性差异(χ2=4.683,P<0.05,OR=2.440)。结论携带GSTT1缺失型基因以及CYP1A1变异型基因的母亲,其发生早产的危险性增大。     

Niemann-Pick C1 Like 1研究新进展

Niemann-Pick C1 Like 1(NPC1L1)是肠道胆固醇吸收的关键蛋白,也是胆固醇吸收抑制剂依泽替米贝的分子作用靶点.NPC1L1的表达受一些核因子受体调控.敲除apoE-/-小鼠NPC1L1基因能显著抑制动脉粥样硬化的发生和发展,为动脉粥样硬化和冠状动脉性心脏病提供了新的治疗靶点.     

环境外暴露及GSTT_1、GSTM_1基因型对1-羟基芘作为多环芳烃暴露标志物的影响

目的研究多环芳烃(PAHs)暴露(环境空气暴露和吸烟)、GSTT1、GSTM1基因型对1-羟基芘(1-OHP)作为PAHs暴露标志物的影响。方法选取51名巡警作为研究组,48名内勤警察作为对照组,测定两组人群环境空气中的PAHS浓度以及尿中的1-OHP浓度,采用HPLC方法分析环境空气中PAHs浓度和研究对象尿样中的1-OHP;PCR方法测定GSTT1、GSTM1基因型。结果对照组环境PAHs浓度为12.79ng/m3,研究组为20.85ng/m3。研究组、对照组内部相同吸烟条件下GSTT1、GSTM1不同基因型人群尿中1-OHP浓度没有差别,相同基因型下的非吸烟人群中,对照组尿中1-OHP浓度均小于研究组,吸烟人群中没有发现同样的规律。按吸烟分层后,研究组、对照组内部吸烟者尿中的1-OHP浓度均大于非吸烟者,并且对照组吸烟者尿中1-OHP浓度大于研究组非吸烟者。结论PAHs暴露及吸烟是影响尿中1-OHP浓度的重要因素;在环境空气中PAHs浓度较低的情况下,吸烟对尿中1-OHP浓度的贡献更大。但GSTT1、GSTM1基因型不是影响尿中1-OHP浓度的主要因素。     

铜川市甲型流感监测流行情况

目的通过甲型流感监测,探索铜川市2009年9月-2010年1月该病流行趋势。方法实时荧光定量PCR方法 (Real-timePCR)。结果共监测476份样本,阳性184份,阳性率38.7%。结论 184份阳性标本中,甲型H1N1阳性样140份,阳性率76.1%。     

CYP1A1和GSTM1基因多态与肺癌发病关系的病例-对照研究

目的 探讨肺癌易感性标记物CYP1A1及GSTM1基因多态以及吸烟等其他环境暴露因素与肺癌发生的关系。方法 采用病例-对照研究的方法，收集原发性肺癌病例91例以及非肺部疾患的住院病例(对照)91例，所有的研究对象均采静脉血进行DNA抽提，并用PCR方法检测CYP1A1以及GSTM1基因多态，同时调查研究对象吸烟等其他环境暴露因素。应用Logistic回归分析方法进行单因素和多因素的分析。结果 无论是单因素分析还是多因素分析均未显示出CYP1A1和GSTM1基因多态与肺癌发病的关联。多因素分析结果表明：化程度的OR为0．63(95％CI：0．45～0．86)，吸烟量的OR为1．56(95％CI：1．14～2．14)，无抽油烟机的OR为3．77(95％CI：1．48～9．56)，食用动物油的OR为1．67(95％CI：1.25～2．24)，常吃胡萝卜的OR为0．47(95％CI：0．22～0．98)，饮酒的OR为6．58(95％CI：1.53～28．30)，家族肺癌史的OR为3．75(95％CI：1．64～8．58)。结论 CYP1A1和GSTM1基因多态与肺癌发病无明显的关联，吸烟、饮酒、食用动物油、家族肺癌吏以及无抽油烟机是肺癌的危险因素，而高化程度和常吃胡萝卜与降低肺癌风险有关。     

1起甲型H1N1流感暴发的调查

[目的]总结甲型H1N1流感暴发的经验、教训,为今后处理类似突发事件提供参考。[方法]采用现况调查的方法,对2009年10月发生在青岛某大学费县校区学生中的甲型H1N1流感暴发疫情进行调查。[结果]此次甲型H1N1流感暴发共发病16例,罹患率为0.28%。病例分布在2个年级、9个班,发病年龄为18-21岁,男生11例,女生5例,男女之比为2.20∶1。患者临床表现为发热、头痛、头晕、咳嗽、腰腿酸痛等症状。无明确与甲型H1N1流感病例和流感样病例接触史。[结论]这是1起发生在学校由甲型H1N1流感病毒感染引起的暴发疫情,控制措施及时有效。     

硫酸基转移酶SULT1E1、SULT1A1基因多态性与子宫平滑肌瘤易感性的关联研究

目的:探讨硫酸基转移酶SULT1E1、SULT1A1基因多态性对子宫平滑肌瘤易感性的影响。方法:采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析法检测子宫平滑肌瘤组和对照组SULT1E1基因rs3736599位点、SULT1A1基因rs9282861位点的多态性情况。结果:①病例组和对照组SULT1E1 rs3736599位点基因型分布差异有统计学意义(P=0.032),携带突变A等位基因(基因型为A/A和A/G)女性发生子宫平滑肌瘤的风险是野生型纯合子G/G女性的3.497倍(P=0.034,OR=3.497,95%CI:1.12～10.91)。②病例组和对照组SULT1A1 rs9282861位点基因型分布差异无统计学意义。结论:硫酸基转移酶SULT1E1基因rs3736599多态性可能与子宫平滑肌瘤易感性相关,携带突变A等位基因可能是子宫平滑肌瘤的危险因素。     

Detection of CYP1A1 gene polymorphism using designed RFLP and distributions of CYP1A1 genotypes in Japanese

Isoleucine (Ile)-valine (Val) polymorphism, which is caused by a point mutation from A to G in exon 7, is reported to be associated with an elevated risk of lung cancer among Japanese. Because CYP1A1 catalyzes bioactivation of environmental procarcinogens, such as benzo[a]pyrene, it is very important to study the clinical meaning of Ile-Val polymorphism using an epidemiological study. In an epidemiological study, easy, economical, rapid and reliable identification of the CYP1A1 genotype is necessary. The present study shows that the new method, designed restriction fragment length polymorphism (designed RFLP), can detect Ile-Val polymorphism of CYP1A1 The Ile-Val polymorphism detected using this new method was consistent with that found by the allele-specific PCR amplifications (ASA) method in six cases tested. This new method detected Ile-Va1 polymorphism of CYP1A1 using 240 healthy Japanese who lived in the northern Kyusyu region. The frequency of the genotypes was as follows: Ile/Ile, 159 (66.2%); Ile/Val, 65 (27.1%); Val/Val, 16 (6.7%). The frequency of the Ile gene was 0.798 and that of the Val gene, 0.202. There was no difference in Ile-Val polymorphism based on sex or age. Racial differences influenced the distribution of this polymorphism, but Japanese regional differences did not. Since this new method, designed RFLP, is rapid, reliable and suitable for large-scale screening of polymorphisms, it may be used routinely to detect Ile-Val polymorphism of CYP1A1 Furthermore, it will help to evaluate the relationship between CYP1A1 polymorphism and individual sensitivity to xenobiotics that may affect the incidence of lung cancer.