甲型H1N1流感病毒临床实验室诊断策略

目的 探讨用于甲型H1N1流感患者临床实验室诊断的策略.方法 采用Dot-ELISA法检测流感患者中的甲型流感病毒的抗原,初步明确为甲型流感或排除非甲型流感;采用real-time RT-PCR法检测甲型流感病毒抗原阳性患者中的甲型H1N1流感病毒特异性核酸,进一步确定甲型H1N1流感病毒.结果 对44 448例在西安地区就诊的发热伴有流感样症状者的鼻咽腔取分泌物进行甲型流感病毒抗原筛查,其阳性筛检率为28.25%;对甲型流感病毒抗原筛查阳性的17 714例患者进行甲型H1N1流感病毒核酸检测,其阳性检出率为41.92%.结论 首先用甲型流感病毒抗原筛查,排除非甲型流感病毒;进而在甲型流感病毒的范围内进行甲型H1N1流感病毒的检测,即加快了甲型流感病毒的排查效率,又减轻了甲型H1N1流感病毒核酸检测的压力;进而又减轻了大部分非甲型H1N1流感患者核酸检测的经济负担.该文认为该检测策略为甲型H1N1流感病毒的临床实验室诊断提供了参考,可为甲型H1N1流感病毒感染的控制、诊断,以及合理用药和针对性治疗提供依据.     

实时荧光RT-PCR检测不同标本中甲型H1N1流感病毒核酸的临床意义

目的通过检测甲型H1N1流感感染患者不同标本中甲型H1N1流感病毒核酸,了解其对甲型H1N1流感的快速诊断及病程进展的关系。方法 118例甲型H1N1流感患者,采用实时荧光逆转录聚合酶链反应法(RT-PCR)分别检测发病48 h后和(或)恢复期咽拭子、血浆及下呼吸道分泌物中甲型H1N1流感病毒核酸。结果 118例甲型H1N1流感患者发病48 h后咽拭子甲型H1N1流感病毒核酸阳性;23例(23/40)重症患者下呼吸道分泌物中甲型H1N1流感病毒核酸阳性;15例(15/40)重症患者血浆中检测到甲型H1N1流感病毒核酸。结论实时荧光RT-PCR方法可以快速检测甲型H1N1流感病毒感染,血浆中甲型H1N1流感病毒核酸阳性可能是重症患者的标志。     

2013-2015年浙江地区新型甲型H1N1流行性感冒的流行病学和临床特征调查

摘要：目的：调查2013-2015年浙江地区哨点医院监测的新型甲型H1N1流行性感冒（简称流感）的临床特征及其流行病学特征。 方法：对2013-2015年浙江地区8家哨点医院纳入的符合急性呼吸道感染的患者进行流行病学和临床特征调查,采集研究对象呼吸道标本进行流感病毒检测,分析新型甲型H1N1流感病毒阳性组与阴性组的临床和流行病学特征。 结果：8家哨点医院共纳入7 602例急性呼吸道感染患者,其中,实验室确诊新型甲型H1N1流感779例（10.2%）,新型甲型H1N1流感患者中位年龄为51岁,115例（33.6%）患有至少1种慢性基础性疾病,新型甲型H1N1流感中哮喘比例（2.6%）高于流感病毒阴性患者（0.6%）,差异有统计学意义（χ²=12.706,P<0.01）。新型甲型H1N1流感中恶心、呕吐所占比例高于流感病毒阴性患者,排痰性咳嗽、腹泻所占比例低于流感病毒阴性患者。新型甲型H1N1流感患者的白细胞计数和中性粒细胞计数均低于流感病毒阴性组,差异均有统计学意义（P<0.05）。 结论：浙江地区人感染新型甲型H1N1流感的高发期为每年的冬春季节,其他时间呈散发。新型甲型H1N1流感的临床症状与非流感患者相比较无特异表现。     

甲型H1N1流感患者丙氨酸氨基转移酶意义分析

目的 探讨甲型H1N1流感患者血清中丙氨酸氨基转移酶(ALT)值的变化与健康人群的差异是否有统计学意义,是否将ALT值作为甲型H1N1流感的辅助诊断.方法 随机抽取201例健康体检者资料和201例甲型H1N1流感患者作比较,统计其ALT值并用统计学方法检验.结果 甲型H1N1流感患者的ALT均值较健康人群高,差异有统计学意义.结论 甲型H1N1流感患者血清中ALT值变动有意义,可作为甲型H1N1流感的辅助诊断.     

荧光定量PCR反应监测发热患者甲型H1N1流感病毒感染

目的通过荧光定量PCR反应监测发热患者甲型H1N1流感病毒感染情况,探讨该方法在流行性感冒检测诊断中的意义。方法采用WHO推荐的荧光定量PCR方法对3361例发热患者咽拭子标本进行病毒核酸检测,确定甲型H1N1流感感染患者。结果共检测有流感样症状患者2156例,甲型流感病毒核酸阳性1176例,阳性率35.0%,其中甲型H1N1流感病毒核酸阳性599例,阳性率17.8%。14岁以下儿童甲型H1N1流感病毒核酸阳性283例,占甲型H1N1流感病毒核酸阳性总数的47.2%。结论实时荧光定量PCR反应快速、准确,适用于H1N1流感病毒感染的早期诊断并可作为监测手段在临床广泛开展,为控制疫情的蔓延发挥了重要作用。     

2009年北京市昌平区甲型H1N1流行性感冒病毒监测结果分析

目的及时了解北京市昌平区2009年流感样病例中甲型H1N1流感病毒感染情况。方法依据《甲型H1N1流感病毒RT-PCR检测技术标准操作规程》,应用一组寡核苷酸引物和双重标记的TaqMan(探针,对呼吸道鼻咽拭子标本中的甲型H1N1流感病毒核酸进行定性检测[实时荧光定量(RT-PCR)法检测甲型H1N1流感病毒]。结果2009年5月18日至11月29日共检测流感样病例标本3647份,检测出甲型H1N1流感病毒核酸阳性标本214份(阳性检测率为5.87%),7月27日检出首例甲型H1N1流感病毒核酸阳性标本,9月14-27日阳性检出数最多(112例)。发病年龄集中在5~岁、10~岁、15~岁和20~岁组,发病人群学生占76.62%,97.40%的病例具有发热症状,其次为咳嗽(42.86%)和咽痛(31.17%)等。结论2009年昌平区流感样病例中甲型H1N1流感病毒感染以学生为主,发病具有明显年龄、人群差异。开展甲型H1N1流感病毒核酸检测,有助于了解甲型H1N1流感病毒感染情况,为临床的诊治以及合理制定甲型H1N1流感病毒防控策略提供依据。     

血清超敏C-反应蛋白在甲型H1N1流感患者中的变化及临床意义

目的探讨检测血清超敏C反应蛋白(hs-CRP)在甲型H1N1流感患者中的变化及临床意义。方法检测79例(轻症42例、重症37例)甲型H1N1流感患者的血清hs-CRP水平,分析和同期40例普通流感患者的血清hs-CRP水平比较。结果甲型H1N1流感患者血清hs-CRP阳性率明显高于普通流感组,差异具有统计学意义(χ2=40.83,P<0.05);重症甲流组血清hs-CRP水平明显高于轻症甲流组及普通流感组,差异具有统计学意义(F=22.80,P<0.05)。结论血清hs-CRP的检测可作为甲型H1N1流感的早期诊断、病情监测的辅助指标。     

2009年四川省绵阳市甲型H1N1流感疫情分析

目的了解四川省绵阳市2009年甲型H1N1流行性感冒(甲型H1N1流感)疫情的流行病学特征。方法从中国疾病预防控制系统和现场调查资料中收集绵阳市甲型H1N1流感疫情的相关信息,采用描述性流行病学方法分析结果。结果 2009年绵阳市共诊断甲型H1N1流感407例,其中,经实验室确诊甲型H1N1流感病例393例,疑似病例14例。重症病例20例,危重病例6例,死亡病例1例。绵阳市所辖9个县(市、区)均有甲型H1N1流感疫情发生,发病数居前3位的依次是涪城区(60.20%)、三台县(18.67%)和安县(6.88%)。发病高峰为9-10月。确诊病例平均年龄16.6岁,男女性别比为1.51∶1。结论绵阳市甲型H1N1流感防控形势严峻,应加强流感样病例监测和重症病例诊断治疗,加强重点人群甲流疫苗接种工作。     

危重症甲型H1N1流感9例治疗体会

目的:探讨危重症甲型H1N1流感的临床特征和诊治经验。方法:对我科重症监护病房收治的9例危重症甲型H1N1流感患者的临床资料进行回顾性分析。结果:患者均因发热、咳嗽入院,甲型H1N1流感核酸检测为阳性,病程中均出现胸闷、气促,8例发生急性呼吸窘迫综合征(ARDS),4例发生多脏器功能不全综合征(MODS)。经抗病毒、机械通气为主的综合治疗措施,甲型H1N1流感核酸检测3～5d转为阴性,最终8例患者康复出院,1例患者死亡。结论:早期明确诊断,早期采取抗病毒、机械通气等综合抢救措施是降低危重症甲型H1N1流感病死率的关键。     

新型护理模式在孕妇甲型H1N1流感预防中的效果分析

[目的]探讨新型护理模式在孕妇甲型H1N1流感预防中的效果.[方法]对500例门诊孕妇实施甲型H1N1流感预检分诊、筛查、健康教育、跟踪随访、轻症病人防治指导等新型护理模式,观察甲型H1N1流感及并发症发生情况、防护和治疗效果.[结果]500例中11例(2.2%)出现轻微甲型H1N1流感症状;489例(97.8%)孕妇平安度过孕产期,未感染甲型H1N1流感.[结论]通过对孕妇实施新型护理模式,有效预防了甲型H1N1流感的感染、加速轻症病人的康复,减少重症病人的发生,对预防和控制甲型H1N1流感的传播蔓延有着极其重要的意义.     

Genetic polymorphism of cytochrome P450 1A1 (Cyp1A1) and glutathione transferases (M1, T1 and P1) among Africans.

The co-ordinate expression and regulation of the drug metabolising enzymes, cytochrome P4501A1 (CYPlAl) and glutathione transferases (GSTM1, GSTT1 and GSTP1), and their metabolic balance in the cells of target organs may determine whether exposure to carcinogens results in cancer. Besides showing variability in activity due to induction and inhibition, these enzymes also exhibit genetic polymorphism that alter enzyme levels and activity. We determined frequencies of common allelic variants of CYP1A1 and glutathione (M1, T1 and P1) among Tanzanians, South African Venda and Zimbabweans using PCR/restriction fragment length polymorphism techniques. The CYP1A1 Val462 mutant variant was found at a frequency of 1.3% among 114 subjects. The GSTM1*0 genotype was found at a frequency of 29% and 33% among Tanzanian psychiatric patients and healthy volunteers, respectively. Similarly, the GSTT1*0 polymorphism was present with a frequency of 25% in both the psychiatric patients and healthy controls. The frequency of GSTP1 Val105 variant was 16%, 12% and 21% among Tanzanians, South African Venda and Zimbabweans, respectively. We conclude here that CYP1A1 Val462 polymorphism is very rare among Africans. This is the first report of the GSTP1 Val105 variant frequency in African populations. We show here that there are no differences in frequencies of the variant alleles for CYP1A1, GSTM1, GSTT1 and GSTP1 in the three African populations.     

Influenza A (H1N1) vs non-H1N1 ARDS: Analysis of clinical course

Purpose

The purpose of the study is to compare H1N1-induced acute respiratory distress syndrome (ARDS) with ARDS due to other causes of severe community-acquired pneumonia focusing on pulmonary function.

Materials and methods

This is a retrospective data analysis of adult ARDS patients between January 2009 and December 2010 in an ARDS referral center. Patient characteristics, severity of illness scores, modalities, and duration of extracorporeal lung support were evaluated as well as intensive care unit stay and survival. Parameters of mechanical ventilation and pulmonary function were analyzed on day of admission and over the consecutive 10 days using a nonparametric analysis of longitudinal data in a 2-factorial design. In a logistic regression analysis, risk factors for extracorporeal lung support were investigated.

Results

Twenty-one patients with H1N1-ARDS and 41 with non-H1N1-ARDS were identified. Gas exchange was more severely impaired in patients with H1N1-ARDS over course of time. Extracorporeal membrane oxygenation was more frequently needed in H1N1-ARDS. Despite significantly prolonged weaning off extracorporeal lung support and intensive care unit stay in H1N1 patients, the proportion of survivors did not differ significantly. Only Sepsis-Related Organ Failure Assessment score could be identified as an independent predictor of extracorporeal lung support.

Conclusions

Clinical course of H1N1-ARDS is substantially different from non-H1N1-ARDS. Affected patients may require extensive therapy including extracorporeal lung support in ARDS referral centers.