甲型H1N1流感病毒耐药性研究进展

2009年4月,墨西哥首先爆发了人感染猪流感疫情,随即疫情迅速在全球范围内蔓延,形成了新一轮的流感大流行。这次流行的猪流感病毒为新型的甲型H1N1流感病毒。世界卫生组织于2009年4月30日正式将其更名为A（H1N1）型流感。目前我国对于甲型H1N1流感的治疗,除了运用传统中医的疗法外,主要是采用神经氨酸     

双重荧光定量RT-PCR快速检测甲型和甲型H1N1流感病毒

目的建立双重荧光RT-PCR快速检测方法,用于甲型和甲型H1N1流感病毒的同时检测和鉴别诊断。方法针对甲型流感病毒M基因和甲型H1N1流感病毒NA基因的保守区序列分别设计特异性引物和Taqman探针,建立优化双重荧光RT-PCR反应体系,评价所建双重RT-PCR反应体系的特异性、敏感性和稳定性,并应用于疑似流感或甲型H1N1流感含漱液标本检测。结果该方法对甲型、甲型H1N1流感病毒检测具有高度特异性,检出限分别为0.01 TCID50和0.1 TCID50,具有较好的稳定性。可从疑似流感或甲型H1N1流感患者含漱液中直接检测到流感病毒核酸。结论本研究建立的双重荧光定量RT-PCR可以同时准确检测甲型和甲型H1N1流感病毒,灵敏度高,稳定性好,是一种快速检测流感病毒的新方法。     

甲型H1N1流感病毒疫苗过敏反应一例

[病例] 女,36岁.在我院门诊于左上臂三角肌皮内注射甲型H1N1流感病毒裂解疫苗0.5 ml(北京科兴生物制品有限公司生产,含甲型H1N1流感病毒血凝素15 μg),约10 min后出现头晕、头痛、恶心、面色苍白、呼吸急促、四肢乏力、站立不稳等症状,立刻在急诊科救治.给予平卧、保暖、吸氧,肾上腺素0.5 mg肌内注射,0.9%氯化钠注射液250 ml加地塞米松10 mg、维生素C 2.0 g静脉滴注,30 min后病情平稳.     

重症甲型H1N1流感患者2例的护理

甲型H1N1流感是甲型流感病毒引起的急性、人畜共患的呼吸道传染性疾病^[1]。病毒主要通过空气和接触传播,儿童、老年人、孕妇、肥胖者以及慢性疾病患者是甲型H1N1流感的高危人群,极易演变为病情凶险、病死率高的甲型H1N1流感重症患者。本院近期收治2例重症甲型H1N1流感患者,现将抢救及护理体会报告如下。     

甲型H1N1流感病毒RNA检测方法的建立及临床应用

目的 建立检测甲型H1N1流感病毒RNA的实时荧光定量逆转录聚合酶链反应(RT-PCR)方法,并探讨其临床应用价值.方法 根据甲型H1N1流感病毒HA基因和NA基因的核苷酸序列和GenBank数据库中的核苷酸序列设计检测特异性引物和TaqMan探针,优化反应体系和反应条件,建立检测甲型H1N1流感病毒RNA的实时荧光定...     

甲型H1N1流感患者实验室指标变化与临床的关系

目的 分析208例甲型H1N1流感患者实验室检测指标,探讨其变化特点对甲型H1N1流感诊断及评估病情发展变化的价值。 方法 在病程中进行血常规、肝、肾功能指标、T淋巴细胞亚群以及其他感染性实验室指标的检测。对检验结果进行回顾性总结和统计学分析。 结果 入院初期绝大多数患者红细胞、血小板计数在正常范围内;43.3%患者白细胞总数下降,有36.1%患者中性粒细胞和16.8%患者淋巴细胞数降低;入院初期绝大多数患者肝、肾功能生化指标正常,部分患者存在电解质紊乱;CD3+、CD4+、CD8+T淋巴细胞数下降比较显著,特别是重症患者,并在入院数天后降至极低值,又随病情好转而回升正常。 结论 CD3+、CD4+、CD8+T淋巴细胞及血常规检查的淋巴细胞计数,是甲型H1N1流感患者早期鉴别诊断以及病情严重程度的重要指标,动态观察其变化对患者的病情发展、疗效观察及预后判断等方面有重要的指导价值。     

甲型H1N1流感病毒裂解疫苗安全性的调查分析

目的 考察甲型H1N1流感病毒裂解疫苗在人群中应用的安全性.方法 在本社区卫生服务中心所管辖的29个社区选择儿童、少年、成人、老年人10298名,依据年龄将观察对象分成3个年龄组,包括7～11岁儿童组2677人,12～17岁少年组4706人,18～90岁成人组2915人.按照程序接种甲型H1N1流感病毒裂解疫苗,然后进行7 d安全性观察,评价不良反应发生情况.结果 接种疫苗后总的不良反应发生率为18.5(‰),成人组最高,达34.3(‰),少年组最低,达2.1(‰),2组之间比较差异显著.轻度不良反应发生率17.5(‰),中度不良反应发生率1.0(‰),未见严重不良反应以及新的、罕见的不良反应.以全身反应为主,其中发热率为9.7(‰),未见局部反应.结论 甲型H1N1流感病毒裂解疫苗安全性良好.     

免疫层析法用于甲型H1N1流感病毒抗原筛查的初步评价

目的 评估免疫层析法检测甲型H1N1流感病毒抗原的准确性,推广免疫层析法在甲流H1N1抗原检测中的临床应用.方法 收集2009年8至12月广东省中医院356例甲型H1N1流感疑似患者的鼻拭子标本,采用免疫层析法进行甲型H1N1流感病毒抗原的快速检测,同时将患者咽拭子送往广州市疾病预防控制中心(CDC)进行甲型H1N1流...     

Vaccination against Human Influenza A/H3N2 Virus Prevents the Induction of Heterosubtypic Immunity against Lethal Infection with Avian Influenza A/H5N1 Virus

Annual vaccination against seasonal influenza viruses is recommended for certain individuals that have a high risk for complications resulting from infection with these viruses. Recently it was recommended in a number of countries including the USA to vaccinate all healthy children between 6 and 59 months of age as well. However, vaccination of immunologically naïve subjects against seasonal influenza may prevent the induction of heterosubtypic immunity against potentially pandemic strains of an alternative subtype, otherwise induced by infection with the seasonal strains.     

甲型h1n1肺炎的ct影像特征

目的:探讨甲型H1N1肺炎CT表现,提高对该病的认识.材料与方法:回顾性分析25例经临床、实验室证实的甲型H1N1肺炎胸部CT表现.25例中男10例,女15例.年龄11～ 33岁,平均25.5岁.白血球计数2.1 × 10^9/L ～ 11.9 × 10^9/L,中性粒细胞百分数27.1％ ～93.1％,淋巴细胞百分数3.6％～57.4％.结果:25例中累及5个肺叶11例(占44.0％),累及4个肺叶6例(占24.0％),累及3个肺叶5例(占20.0％),累及2个肺叶3例(占12.0％).磨玻璃样影8例(占32.0％),表现为小片状及云雾样淡薄影,边缘模糊;实变影10例(占40.0％),表现为团片状、斑片状及棉球样影,密度较高;磨玻璃影合并实变影7例(占28.0％),表现为云雾样淡薄影与棉球样实变影同时存在.25例中实变影中可见支气管充气征8例(占32.0％);病灶内合并网格样改变7例(占28.0％);合并小结节影5例(占20.0％);合并两侧胸腔少量积液2例(占8.0％).结论:甲H1N1肺炎病变以多发,分布范围广,病灶变化快,CT表现具有一定特征.     

Treating Critical Illness Caused by the 2009 H1N1 Influenza A Virus

Background

The 2009 H1N1 influenza A pandemic has set the world spinning, unexpectedly producing significant morbidity and mortality in young, otherwise healthy patients.

Discussion

As the virus spreads across the Northern Hemisphere, emergency physicians are confronted with the challenging task of caring for the many that become critically ill from this pathogen. With the exception of a few observational studies and case reports, there is little information to guide the emergency physician in resuscitating and delivering critical care to a rapidly deteriorating patient. Many moribund patients with 2009 H1N1 influenza A infection require non-conventional critical care therapies.

Conclusion

In this article, we describe the case of a critically ill patient with confirmed 2009 H1N1 influenza A infection. After a brief review of the unique characteristics of this virus, we discuss the management of critically ill patients burdened by infection with 2009 H1N1 influenza A.     

甲型H1N1流感病毒性肺炎的胸部X线和CT表现

目的总结甲型H1N1流感病毒性肺炎患者的胸部X线和CT表现特征。方法回顾分析2009年3月-11月3例经临床表现及病原学检查证实的甲型H1N1流感病毒性肺炎的胸部X线、CT表现。结果肺部病灶多呈散在小片状高密度影,边缘模糊,邻近胸膜;病变最常累及肺基底段;病灶多有少量胸腔积液;病灶有扩散迅速,合理用药后消失较快的特点;病灶吸收落后于临床表现。结论甲型H1N1流感病毒性肺炎的X线、CT表现具有一定的特点,总结并掌握这些特点,有利于早期诊断。其确诊有赖于实验室检查和流行病学调查。     

重型甲型H1N1流感患者临床特征分析

[目的]探讨甲型H1N1流感重症和危重症病例的临床特点.[方法]本院EICU收治18例合并重症肺炎或急性呼吸窘迫综合征（ARDS）患者,对其发病特点、治疗方法及转归等资料进行分析.[结果]所有病例表现为发热和呼吸系统症状,主要临床特点为高热持续不退,呼吸困难,白细胞数及炎症反应指标升高,免疫功能紊乱,胸部影像改变特点为进展快,双肺多叶受累,以广泛肺实质浸润为主,部分病例出现肺间质渗出、支气管充气征,甚至ARDS改变.17例康复出院,另一例病情已平稳,康复治疗中.[结论]重型甲型H1N1流感病情进展快,以呼吸困难、低氧血症为突出表现,肺部病变广泛,进展迅速,有呼吸道基础疾病或免疫抑制状态合并细菌感染是甲型H1N1发生重型和死亡的高危因素,早期奥司他韦抗病毒、呼吸支持、控制混合感染及免疫调节等综合治疗是降低病死率的关键.     

妊娠期妇女甲型H1N1流感52例临床观察

目的探讨妊娠期甲型H1N1流感的临床特点。方法对乌鲁木齐市妇幼保健院2009年11月2010年1月收治的妊娠期甲型H1N1流感临床资料进行回顾性分析。结果同期住院非甲流孕产妇1856例,确诊甲型H1N1流感52例,发病率2.7%。妊娠期甲型H1N1流感的发热时限及不同孕期与病程时限均无相关关系。使用磷酸奥司他韦（达菲）治疗23例,较未使用此药物患者病程显著缩短[（4.79±2.04）d比（7.26±3.77）d,P〈0.05]。合并肺炎6例,病程较无合并症患者显著延长[（9.83±4.70）d比（5.37±2.54）d,P〈0.05]。结论妊娠期甲型H1N1流感应予以高度重视,在早预防、早诊断及早治疗的基础上,提早预防合并症的发生。明确诊断后及早使用磷酸奥司他韦可缩短疗程。     

Comparative Pathogenesis of an Avian H5N2 and a Swine H1N1 Influenza Virus in Pigs

Pigs are considered intermediate hosts for the transmission of avian influenza viruses (AIVs) to humans but the basic organ pathogenesis of AIVs in pigs has been barely studied. We have used 42 four-week-old influenza naive pigs and two different inoculation routes (intranasal and intratracheal) to compare the pathogenesis of a low pathogenic (LP) H5N2 AIV with that of an H1N1 swine influenza virus. The respiratory tract and selected extra-respiratory tissues were examined for virus replication by titration, immunofluorescence and RT-PCR throughout the course of infection. Both viruses caused a productive infection of the entire respiratory tract and epithelial cells in the lungs were the major target. Compared to the swine virus, the AIV produced lower virus titers and fewer antigen positive cells at all levels of the respiratory tract. The respiratory part of the nasal mucosa in particular showed only rare AIV positive cells and this was associated with reduced nasal shedding of the avian compared to the swine virus. The titers and distribution of the AIV varied extremely between individual pigs and were strongly affected by the route of inoculation. Gross lung lesions and clinical signs were milder with the avian than with the swine virus, corresponding with lower viral loads in the lungs. The brainstem was the single extra-respiratory tissue found positive for virus and viral RNA with both viruses. Our data do not reject the theory of the pig as an intermediate host for AIVs, but they suggest that AIVs need to undergo genetic changes to establish full replication potential in pigs. From a biomedical perspective, experimental LP H5 AIV infection of pigs may be useful to examine heterologous protection provided by H5 vaccines or other immunization strategies, as well as for further studies on the molecular pathogenesis and neurotropism of AIVs in mammals.