孕妇甲型H1N1流感的影像学表现

目的 研究孕妇甲型H1N1流感影像特点.方法 回顾性分析经临床诊断证实的14例甲型H1N1流感孕妇的资料,所有病例均行胸部X线片及CT影像学检查,实验室检查.结果 所有病例在出现临床症状后胸部影像学检查均有异常表现,轻症患者8例,其中6例为单个肺叶磨玻璃密度及片状高密度,2例双肺下叶片状高密度,3例伴少量胸腔积液;重症患者6例,表现为双肺多叶受累团絮状高密度,同时伴有胸腔积液及心包积液.结论 甲型H1N1流感孕妇患者影像学征像为非特异性急性感染性病变,有一定特征性,影像学检查有助于其早期诊断及鉴别诊断.     

甲型H1N1流感危重症患者胸部影像学变化临床研究

目的总结甲型H1N1流感危重症患者胸部影像学动态变化及其与治疗的关系。方法观察2009年11月-2010年2月ICU收治的甲型H1N1流感危重症患者临床症状和胸部影像学变化的特点,比较其治疗前后的变化情况。结果共有7例符合卫生部甲型H1N1流感危重症患者,均在出现临床流感样症状后约7 d病情明显加重,表现为严重呼吸窘迫、低氧血症性呼吸衰竭,平均氧合指数(PaO2/FiO2)<200 mm Hg,胸部影像学表现为大片斑片状浸润影,所有患者在奥司他韦抗病毒治疗同时均给予呼吸支持,其中2例因无创机械通气效果不佳改为经口气管插管有创机械通气,所有患者均给予白蛋白提高血管内胶体渗透压利尿等治疗措施后,临床症状缓解,胸部影像学表现浸润影有吸收;治愈患者出院后随访1个月肺部有不同程度纤维化表现。结论甲型H1N1流感危重症患者肺组织损害重,临床治愈患者出现不同程度肺组织纤维化。     

儿童甲型H1N1流感并发肺部感染的胸部X线表现

目的 探讨儿童甲型H1N1流感并发肺部感染的胸部X线检查价值和影像表现.方法 回顾性分析8例临床实验室确诊的儿童甲型H1N1流感患者胸部X线资料,患者在隔离病房进行移动式床旁X摄影系统(CR)卧位胸部检查,CR扫描成像后分析影像资料.结果 8例甲型H1N1患者肺部X线表现为双肺下纹理增多,边缘模糊,伴有沿肺纹理走行的小...     

儿童危重症甲型H1N1流行性感冒5例临床分析

目的 探讨甲型H1N1流行性感冒（简称流感）危重症患儿的临床特点,为重症病例的识别提供临床依据. 方法 回顾性分析5例甲型H1N1流感危重症患儿的临床资料. 结果 3例以呼吸系统症状起病,如咳嗽、流涕、咽喉痛等流感样症状,其中2例出现进行性呼吸困难,合并呼吸衰竭,1例合并脂肪酸代谢障碍,1例合并链球菌感染;1例以神经系统症状起病,如头痛、嗜睡、反复抽搐、并进入浅昏迷;1例以消化系统症状起病,如恶心、呕吐、腹痛、腹泻,伴有脑病表现,血小板进行性下降,继发川崎病.5例息儿均有发热,神经系统受累;流感病毒A抗体检测均阳性,血沉、C反应蛋白升高;2例血小板下降,谷丙氨酸转移酶和心肌酶明显升高;3例血凝分析异常,胸部CT示双肺广泛渗出性改变.5例患儿死亡2例,治愈3例. 结论 甲型H1N1流感重症患儿多以呼吸道症状起病,临床表现呈多样性,多伴有神经系统受累,可累及多个系统及脏器,出现急性呼吸窘迫综合征,患儿预后较差.     

重症甲型H1N1流感典型病例的临床特征和诊治经验

[目的]探讨重症甲型H1N1流感典型病例的临床特征和诊治经验.[方法]对收治的重症甲型H1N1流感确诊病例采取积极的诊断与治疗措施.[结果]所有确诊重症甲型H1N1流感病例均有流感样症状,包括发热(腋下温度≥37.5℃)、咽痛、流涕、肌内酸痛(100%);体温≥39℃并持续3 d以上16例;咳嗽、咳痰19例,头痛、头昏11例;胸闷、气促10例;水样便腹泻或呕吐5例;神志淡漠或烦躁7例;肺部湿性哕音5例.20例继发肺炎或支气管炎,其中2例为重症肺炎;急性呼吸衰竭1例;多器官功能障碍综合症1例.所有患者咽拭子甲型H1N1病毒核酸检测均阳性;WBC正常11例,WBC减少(<5.0×109/L)7例,WBC增高(>10.0×109/L)5例;淋巴细胞(L)正常(0.8～5.0×109L)17例,L减低(<0.8×109/L)5例;胸部CT斑片状浸润影19例,肺纹理增粗、紊乱3例;ECG正常16例;T波改变、ST-T压低7例.所有患者治疗时间7～15 d,平均时间(7.6±2.3)d.所有病例体温正常大于3 d,流感样症状消失,临床症状稳定.咽拭子甲型H1N1病毒核酸检测均阴性.所有患者均临床治愈.[结论]早期有效的诊断和治疗是降低重症甲型H1N1流感病死率的关键.     

甲型H1N1流感并发肺部感染85例临床分析

目的 了解甲型H1N1流感并发肺部感染的临床特征,提高临床医师对本病的认识.方法 回顾性分析我院2009年8月1日至2009年12月31日收治的85例甲型H1N1流感合并肺部感染确诊病例资料.结果85例患者中,56例为学生,11例有明确接触史.昆明地区79例,其余6例分别来自于3个县.临床主要表现为流感样症状,包括发热(85例)、咳嗽(85例)、咽痛(67例)等.体征包括咽部充血(82例)、扁桃体肿大(79例)、双肺呼吸音粗或可闻及干、湿性啰音(85例)等.外周血WBC偏低51例,占60.0%.胸部CT或X线检查主要表现为肺纹理增粗、支气管炎、支周炎、肺炎、胸腔积液、胸膜增厚.治疗首选奥司他韦(达菲),未见不良反应,多数患者可以耐受.结论 新型甲型H1N1流感传染性强,合并肺部感染时症状加重,易发展成重症,应引起临床医师的高度重视.     

郑州地区988例甲型H1N1流行性感冒临床特征分析

目的 了解郑州地区新型甲型H1N1流行性感冒(流感)的临床特征,提高临床医师对本病的认识.方法 采用描述性流行病学方法对河南省传染病医院2009年5月1日～12月30日收治确诊的988例甲型H1N1流感患者资料进行回顾性分析.结果 本组患者男546例,女442例,年龄0.4 ～77岁.临床主要表现为流感样症状,包括发热、咳嗽、流涕、咽痛,其他症状有头痛、全身酸痛、恶心呕吐、腹泻等,体征有咽部充血及扁桃体肿大等.外周血WBC总数正常或偏低,单核细胞增多.胸部X线检查主要表现为肺纹理增多、肺炎、胸膜炎等.治疗首选奥司他韦,不良反应少见,可作为常规用药.本病预后良好,死亡率0.71％.危重病人多合并呼吸系统并发症,常需要机械辅助呼吸.结论 新型甲型H1N1流感传染性强,但症状轻微,死亡率不高.     

甲型H1N1流感重症肺炎临床分析

目的分析医院甲型H1N1流感重症肺炎的临床资料,总结防治措施,积累临床救治经验。方法对2009年11月28日-12月5日医院收治的甲型H1N1流感重症肺炎5例临床资料进行回顾性分析。结果 5例甲型H1N1流感患者均系咽拭子标本检测病毒核酸阳性的确诊病例;均表现为Ⅰ型呼吸衰竭,符合重症肺炎诊断标准;伴随症状可表现为胸痛(2例)、乏力(3例)、肌肉酸痛(3例),ALT、AST、LDH、CK、CK-MB增高(5例),CRP明显升高(5例),血小板正常(5例),白细胞减少(3例),白细胞正常(2例);胸部影像学表现为斑片、片状、毛玻璃影及间质性改变,以两侧肺底为主(5例),病灶可以快速进展;5例患者均接受奥司他韦抗病毒、β-内酰胺类联合新喹诺酮类抗感染及氧疗,症状明显好转,咽拭子甲型H1N1流感病毒核酸检测结果转阴性,复查胸部X线及CT病灶好转,康复出院。结论急性起病,发热、咳嗽、咯血、呼吸困难,血常规检查WBC低或不高,胸部影像学显示两下肺为主的斑片、片状及间质性改变,病灶快速进展,伴血LDH、CK、CK-MB、ALT、AST升高者,要高度警惕甲型H1N1流感,尽早检测呼吸道标本甲型H1N1流感病毒核酸,早诊断、早治疗、预后相对较好。     

孕产妇甲型H1N1流感重症患者临床特征与治疗分析

目的分析孕妇甲型H1N1流感重症患者临床特点、治疗策略,为治疗甲型H1N1流感重症提供理论依据。方法对3例甲型H1N1流感孕产妇重症患者的临床特征、实验室表现、影像学变化和治疗手段进行分析。结果 2例患者进行了剖宫产,1例做了引产,其中1例患者出现脑疝死亡。结论甲型H1N1流感孕产妇疾病发展迅速,并发症多,常合并多脏器衰竭,发病机制复杂,治疗上晚期孕妇及早终止妊娠,积极抗病毒和生命支持治疗至关重要。     

高校甲型H1N1流感的流行病学特征及疫苗预防的效果分析

[目的]观察高校甲型H1N1流感的流行病学特征,评价甲型H1N1流感疫苗的预防效果.[方法]回顾性分析2009年10月5日～11月9日我院隔离病房收治的甲型H1N1流感确诊病例29例,观察患者流感相关症状、体征的动态情况.对13 197名高校教职工及学生进行甲型H1N1流感疫苗接种,与同期匹配的未接种人群比较甲型H1N1流感发生情况、流感样症状发生情况及上呼吸道感染发生情况.[结果]29例甲型H1N1患者均咽部充血,大部分患者发热,部分患者头痛、鼻塞、流涕、乏力、肌肉酸痛等.接种疫苗可显著减少甲型H1N1流感的发生率(P<0.05),预防有效率为77.81%;且接种后流感样症状发生率明显降低,与对照组有统计学差异(P<0.05),预防有效率为78.35%;此外,两组上呼吸道感染发生率有统计学差异(P<0.05),预防有效率为53.84%.接种疫苗后副反应发生率为0.77%.[结论]掌握甲型H1N1流感的流行病学特征,有助于为疫情的防控提供科学依据,甲型H1N1流感疫苗可有效预防甲型H1N1流感及其他相关疾病的发生.     

H1N1 influenza is here

On 11 June WHO announced that the spread of H1N1 had reached pandemic phase 6. Since then countries around the world have increased their planning and preparedness for the continuing pandemic. Guidelines have been issued and circulated but confusion continues over their interpretation. We need to remind ourselves of the principles behind control measures and educate and reinforce standard infection control procedures in the acute hospital setting.     

甲型H1N1流感疫苗接种对其暴发疫情的影响

目的了解甲型H1N1流感(甲流)疫苗接种后对甲流暴发疫情的影响。方法对2011年4—5月发生在学校的1起甲流暴发疫情进行流行病学描述性分析,用回顾性队列研究的方法分析甲流疫苗接种对该起暴发疫情的影响。结果该校542名师生中191人患病,罹患率为35.24%,发病时间主要集中在4月19—25日,发病人群主要为1～6年级的小学生(χ2=9.972,P0.01),住校生发病高于非住校生,112名接种过甲流疫苗的师生发病率为16.96%,明显低于未接种疫苗的师生(40%),差异有统计学意义(χ2=20.661,P0.05),OR=0.306(95%CI∶0.180～0.521)。结论接种甲流疫苗可以有效预防甲型H1N1流感的发生,减少暴发疫情的发病率。     

无锡市甲型H1N1流感及季节性流感疫苗接种效果分析

目的调查流感样病例(ILI)和无锡市一般人群中甲型H1N1流感疫苗及季节性流感疫苗的接种情况,评估疫苗接种后对人群的保护效果。方法以无锡市2家哨点医院为基础,采集流感样病例病毒核酸检测阳性的病例作为病例组,共1 529人,同时按照"病例"的电话信息,随机产生电话号码选择、年龄匹配的一般人群作为对照组,共380人。结果病例组甲型H1N1流感疫苗接种率为6.1%(94/1 529),对照组甲型H1N1流感疫苗接种率为12.1%(46/380),两组比较,差异有统计学意义(P0.01);甲型H1N1流感病例中接种甲型H1N1流感疫苗的比例为12.5%(3/24),门诊检测阴性的ILI病例接种甲型H1N1流感疫苗的比例为6.1%(78/1 273),"接种甲型H1N1流感疫苗"因素的OR值为0.457(P=0.201);以电话调查一般人群(330例)作为对照组,接种甲型H1N1流感疫苗的比例为13.3%(44/330),OR值为1.077(P=0.908)。结论该次调查说明接种甲型H1N1流感疫苗对预防流感样病例有一定效果,但由于样本量较少,24种方法病例对照分析均未得出差异有统计学意义。     

1例儿童危重症甲型H1 N1流感伴右侧气胸的护理体会

目的：探讨儿童危重症甲型HINI流感伴气胸的护理要点及方法。方法回顾分析1例危重症甲型H1N1流感伴右侧气胸患儿各种临床表现的护理及并发症的预防等。结果该患儿经气管插管,呼吸机辅助呼吸,持续胸腔闭式引流抗感染,化痰,抗病毒等治疗及护理,两周后治愈出院。结论积极配合医生的治疗及对症采取有效的护理措施是治愈危重症甲型HINI流感的关键。     

首起社区甲型H1N1流行性感冒伴季节性流行性感冒暴发的调查分析

Objective To timely summarize past experience and to provide more pertinent reference for control and prevention in A/H1N1 cases in influenza season. Methods During May 25 to 31,2009,2 secondary community cases caused by a influenza A/H1N1 imported case. In the close contacts of 3 A/ H1N1 cases, 14 had some aspiratory symptoms onset, such as fever(≥ 37.5℃), cough, sore throat and etc. Laboratory tests excluded the infection of A/H1N1 influenza. For throat swab test for the 14 cases,7 were tested for seasonal influenza virus. A face-to-face or telephone interview was conducted by CDC staff to collect information of 62 close contacts. Results Of 14 fever cases,there was no significant by differences by age [15-age group: 19. 2% (5/26), over 25-age group: 25.0% (9/36); χ2=0. 287, P=0. 592]; by sex group [24. 0% (6/25) for male and 21.6% (8/37) for female; χ2=0. 048, P=0. 826], by working units [dressing and design, photograph, saleroom and others, consumer group: 42. 1% (8/19), 27. 3% (3/11), 12. 5% (2/16) and 6. 3% (1/16); χ2=7. 653, P=0. 054], by dormitory style [dormitory style=33.3% (4/12),non-dormitory style=29.4%(10/34); χ2=0. 699,P=0. 403]. All the cases had fever (37.5-37.9℃),no case had diarrhea. One in 3 A/H1N1 cases had diarrhea. All the 14 cases were negative result for A/H1N1 RNA. Six from 7 cases were positive for seasonal influenza test. Conclusion This was a seasonal influenza outbreak happened in the close contacts of first confirmed A/H1N1 cases in community in mainland China. It showed that we should exclude the seasonal influenza in the investigation of A/H1N1 cases in the seasonal influenza period in some time. It is necessary to take effective measure to strengthen the control and prevention of seasonal influenza.     

An elastase-dependent attenuated heterologous swine influenza virus protects against pandemic H1N1 2009 influenza challenge in swine

Influenza virus infections continue to cause production losses in the agricultural industry in addition to being a human public health concern. The primary method to control influenza is through vaccination. However, currently used killed influenza virus vaccines must be closely matched to the challenge virus. The ability of an elastase-dependent live attenuated influenza A virus was evaluated to protect pigs against the pandemic H1N1 2009 influenza virus. Pigs vaccinated intranasally or intratracheally with the elastase-dependent swine influenza virus (SIV) vaccine had significantly reduced macroscopic and microscopic lung lesions and lower viral loads in the lung and in nasal swabs. Thus, elastase-dependent SIV mutants can be used as live-virus vaccines against swine influenza in pigs. In addition, low levels of cross-neutralizing antibodies to H1N1 2009 were elicited prior to challenge by the swine adapted H1N1 avian strain vaccine.     

甲型H1N1流感大流行前后沈阳地区流感病原学流行特征

目的分析甲型H1N1流行性感冒(流感)大流行前后沈阳流感病原学流行特征。方法采集2005年10月—2011年3月连续5.5 a哨点医院的流感样病例咽拭子,进行流感病毒的分离和分型鉴定,并按甲型H1N1流感流行前后划分为3个时期。结果 3个时期共采集流感样病例咽拭子样本6 808份,分离到流感病毒861株,总分离率为12.6%;流行前、流行中和流行后3个时期流感病毒检出率分别为13.8%、18.2%和5.2%。男性和女性流感病毒感染率差异无统计学意义,不同时期流感样病例的年龄构成差异有统计学意义。新的甲型H1N1流感侵袭的人群主要是低年龄组人群,新的甲型H1N1流行期间和流行后,流感季节高峰发生前移。不同年度流感流行毒株型别不同,前1年监测周期的优势株在下1个周期中可被其他型别抑制甚至取代。结论甲型H1N1流感流行后沈阳的流感流行特征已发生了部分改变,这种改变是否持续存在还有待持续监测来得以验证,在2011—2012年监测周期中应密切关注A3(H3N2)亚型和新的甲型H1N1亚型流感毒株的活动情况。     

Efficacy of inactivated swine influenza virus vaccines against the 2009 A/H1N1 influenza virus in pigs

The gene constellation of the 2009 pandemic A/H1N1 virus is a unique combination from swine influenza A viruses (SIV) of North American and Eurasian lineages, but prior to April 2009 had never before been identified in swine or other species. Although its hemagglutinin gene is related to North American H1 SIV, it is unknown if vaccines currently used in U.S. swine would cross-protect against infection with the pandemic A/H1N1. The objective of this study was to evaluate the efficacy of inactivated vaccines prepared with North American swine influenza viruses as well as an experimental homologous A/H1N1 vaccine to prevent infection and disease from 2009 pandemic A/H1N1. All vaccines tested provided partial protection ranging from reduction of pneumonia lesions to significant reduction in virus replication in the lung and nose. The multivalent vaccines demonstrated partial protection; however, none was able to prevent all nasal shedding or clinical disease. An experimental homologous 2009 A/H1N1 monovalent vaccine provided optimal protection with no virus detected from nose or lung at any time point in addition to amelioration of clinical disease. Based on cross-protection demonstrated with the vaccines evaluated in this study, the U.S. swine herd likely has significant immunity to the 2009 A/H1N1 from prior vaccination or natural exposure. However, consideration should be given for development of monovalent homologous vaccines to best protect the swine population thus limiting shedding and the potential transmission of 2009 A/H1N1 from pigs to people.     

Ganglioside GM1b as an influenza virus receptor

Receptor activity toward influenza virus A/Aichi/2/68 (H₃N₂) of a pair of gangliosides, GM1b (NeuAcα2–3Galβ1–3GalNAcβ1–4Galβ1–4Glcβ1-1′-ceramide) and GM1a (Galβ1–3GalNAcβ1–4(NeuAcα2–3)Galβ1–4Glcβ1-1′ -ceramide) is described. Receptor activity was monitored by an assay system including incorporation of gangliosides into chicken asialoerythrocytes which had lost the biological response for the virus, and subsequent estimation of recovery of virus-mediated haemagglutination and haemolysis. GM1a and GM1b were incorporated in similar amounts into chicken asialoerythrocytes. It was found that GM1b-erythrocytes revealed distinct recovery of influenza virus A/Aichi-mediated agglutination at 4°C and subsequent haemolysis at 37°C at pH 5.3. However, restoration of biological responsiveness of the erythrocytes to the virus by incorporation of GM1a was very low under the same conditions. The above results indicate that the haemagglutinin of the influenza virus A/Aichi/2/68 (H₃N₂) recognizes the saliosyl residue linked to nonreducing ‘terminal’ galactose rather than ‘inner’ galactose in the ganglio-tetraose core of gangliosides. GM1b could be one of the functional receptors to the influenza virus.     

甲型H1N1流感住院病例28例临床分析

目的分析2009年5月至12月收治确诊28例甲型H1N1流感病例的临床特征。方法应用描述性流行病学方法对28例确诊甲型H1N1流感病例患者的年龄、性别、主要临床特征、治疗效果进行分析。结果发病年龄主要集中在8～54岁,平均25.5岁,男性22例,女性6例。18例轻病例及8例重症病例均治愈。2例重症病例死亡。发热占100%,咳嗽占64.29%、咽痛占17.86%。高热组症状持续时间与体温正常组比较差异无统计学意义(P0.05)。重症病例合并心肌损害、Ⅰ型呼衰、肝、肾损害、白蛋白降低。结论本组病例轻型者以上呼吸道感染症状为主,预后较好。基础疾病加重本病发展,重症病例住院天数较长,表现复杂,需综合治疗多获治愈。