中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

湖南省 2013 至 2017 年人感染 H7N9 禽流感成人住院患者临床特征分析

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目的总结和分析湖南省人感染 H7N9 禽流感确诊病例的流行病学资料和临床特征,为该病的防控、诊治提供科学依据。方法收集湖南省 2013 年 3 月 1 日至 2017 年 4 月 20 日期间报告的人感染 H7N9 禽流感实验室确诊病例 91 例,除外年龄<18 岁(n=2)及重要数据缺失(n=10)的患者,共 79 例 H7N9 患者纳入分析。总结该病的人口统计学资料、临床特点及抗病毒药物使用情况。结果湖南省内人感染 H7N9 禽流感发病集中在第二波和第五波,第五波中患病人数超过前 4 波总和,但流行病学特征、临床症状及病死率并无明显变化。第五波中抗病毒药物应用更积极,从发病到抗病毒药物使用时间比第二波短[(6.3±2.4)d 比(7.6±2.4)d,P=0.047]。多因素 Logistic 回归分析显示休克是 H7N9 患者死亡的独立危险因素(OR=4.683,95%CI 1.136~19.301,P=0.033)。奥司他韦组、奥司他韦+帕拉米韦组、帕拉米韦组患者的病死率无显著差异。结论湖南省第五波人感染 H7N9 禽流感疫情较前扩散,但临床特征变化不大,抗病毒治疗应更加积极。休克是 H7N9 患者死亡的独立危险因素。奥司他韦和帕拉米韦联合抗病毒并不显著改善病死率。

ObjectiveTo analyze the clinical and epidemiological characteristics of hospitalized avian influenza A (H7N9) virus infections in Hunan province from 2013 to 2017, and provide evidences for control, diagnosis and treatment of this disease.MethodsNinety-one hospitalized patients were confirmed with H7N9 infection in Hunan. Excluding 2 patients less than 18 years old and 10 with missing data, 79 patients with H7N9 infection were analyzed.ResultsMost confirmed cases were affected in the second and fifth epidemic wave and number of patients in the fifth wave was more than the sum in prior 4 waves. Epidemiological characteristics, clinical symptoms and case fatality did not change significantly. Administration of antiviral drugs was more active in the fifth wave [from illness onset to antiviral drug: (6.3±2.4)d vs. (7.6±2.4)d, P=0.047]. Multiple logistic regression analysis showed that shock (OR=4.683, 95%CI 1.136–19.301, P=0.033) was the independent risk factor of H7N9 infections. There were no significant differences in case fatality among group oseltamivir, group oseltamivir+peramivir, and group peramivir.ConclusionsPatients with avian influenza A (H7N9) increased in the fifth wave but clinical characteristics changed little. Antiviral treatment should be more active. Shock is an independent risk factor of H7N9 infections. Oseltamivir-peramivir biotherapy can not reduce case fatality compared with oseltamivir or peramivir monotherapy.

关键词: 人感染 H7N9 禽流感; H7N9; 禽流感; 临床特征; 抗病毒

Key words: Human infections with avian influenza A (H7N9) virus; H7N9; Avian influenza; Clinical characteristics; Antivirus

引用本文: 易丽姗, 胡成平, 张恒娇, 李再清, 杨湘永, 周永升, 李炽观, 贺喜强. 湖南省 2013 至 2017 年人感染 H7N9 禽流感成人住院患者临床特征分析. 中国呼吸与危重监护杂志, 2018, 17(4): 341-347. doi: 10.7507/1671-6205.201801025 复制

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1. Gao R, Cao B, Hu Y, et al. Human infection with a novel avian-origin influenza A (H7N9) virus. N Engl J Med, 2013, 368(20): 1888-1897.
2. 世界卫生组织. 人感染甲型 H7N9 禽流感病毒——中国. (2018-06-13)[2018/6/13]. http://www.who.int/csr/don/20-april-2017-ah7n9-china/zh/.
3. Xiang NJ, Li XY, Ren RQ, et al. Assessing change in avian influenza A (H7N9) virus infections during the fourth epidemic -- China, September 2015-August 2016. Morb Mortal Wkly Rep, 2016, 65(49): 1390-1394.
4. Zhou L, Ren R, Yang L, et al. Sudden increase in human infection with avian influenza A (H7N9) virus in China, September-December 2016. Western Pac Surveill Response J, 2017, 8(1): 6-14.
5. 国家卫生和计划生育委员会. 人感染 H7N9 禽流感诊疗方案(2017 年第 1 版). 中国病毒病杂志, 2017, 7(1): 1-4.
6. Tan KX, Jacob SA, Chan KG, et al. An overview of the characteristics of the novel avian influenza A H7N9 virus in humans. Front Microbiol, 2015, 6(140): 140-151.
7. 刘国贤, 刘荣强, 王正良, 等. 一起家庭聚集性人感染 H7N9 禽流感事件调查. 实用预防医学, 2015, 22(7): 826-828.
8. 钟群, 高立冬, 陈伯中, 等. 一起家庭聚集性人感染 H7N9 禽流感疫情的流行病学调查. 实用预防医学, 2017, 24(9): 1140-1142.
9. Li Q, Zhou L, Zhou M, et al. Epidemiology of human infections with avian influenza A (H7N9) virus in China. N Engl J Med, 2014, 370(6): 520-532.
10. 华伟玉, 刘锋, 孙亚敏, 等. 一例儿童轻型人感染 H7N9 禽流感确诊病例调查. 国际病毒学杂志, 2015, 22(1): 62-64.
11. 曾玫, 朱燕凤, 葛艳玲, 等. 中国确诊的首例儿童 H7N9 禽流感. 中华儿科杂志, 2013, 51(9): 665-669.
12. Wang C, Yu H, Horby PW, et al. Comparison of patients hospitalized with influenza A subtypes H7N9, H5N1, and 2009 pandemic H1N1. Clin Infect Dis, 2014, 58(8): 1095-1103.
13. Yang ZF, Mok CK, Liu XQ, et al. Clinical, virological and immunological features from patients infected with re-emergent avian-origin human H7N9 influenza disease of varying severity in Guangdong province. PLoS One, 2015, 10(2): e117846.
14. Wu W, Shi D, Fang D, et al. A new perspective on C-reactive protein in H7N9 infections. Int J Infect Dis, 2016, 44(C): 31-36.
15. 徐冲, 董丽霞, 曹洁. 降钙素原在社区获得性肺炎预后评估中的价值. 中国呼吸与危重监护杂志, 2017, 16(2): 117-121.
16. Poddar B, Gurjar M, Singh S, et al. Reduction in procalcitonin level and outcome in critically ill children with severe sepsis/septic shock-A pilot study. J Crit Care, 2016, 36(2016): 230-233.
17. Leung YH, To MK, Lam TS, et al. Epidemiology of human influenza A(H7N9) infection in Hong Kong. J Microbiol Immunol Infect, 2015, 2(50): 183-188.
18. Cao B, Gao H, Zhou B, et al. Adjuvant corticosteroid treatment in adults with influenza A (H7N9) viral pneumonia. Crit Care Med, 2016, 44(6): e318-e328.
19. Hu Y, Lu S, Song Z, et al. Association between adverse clinical outcome in human disease caused by novel influenza A H7N9 virus and sustained viral shedding and emergence of antiviral resistance. Lancet, 2013, 381(9885): 2273-2279.
20. Smee DF, Hurst BL, Wong MH, et al. Combinations of oseltamivir and peramivir for the treatment of influenza A (H1N1) virus infections in cell culture and in mice. Antiviral Res, 2010, 88(1): 38-44.
21. Zhang Y, Gao H, Liang W, et al. Efficacy of oseltamivir-peramivir combination therapy compared to oseltamivir monotherapy for Influenza A (H7N9) infection: a retrospective study. BMC Infect Dis, 2016, 16(1): 76-84.
22. Pizzorno A, Abed Y, Rhéaume C, et al. Oseltamivir-zanamivir combination therapy is not superior to zanamivir monotherapy in mice infected with influenza A(H3N2) and A(H1N1)pdm09 viruses. Antiviral Res, 2014, 105(3): 54-58.