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目的探讨人感染高致病性H5N1亚型禽流感的临床特征及防治手段。方法2005年11月,救治1例确诊为感染高致病性H5N1亚型禽流感的青年女性患者,分析其临床表现、影像学及流行病学特点。结果患者发病前与病死家禽有密切接触史,从发病至死亡约10 d。在呼吸困难发生前,发热持续了5 d,以急性社区获得性肺炎及急性呼吸窘迫综合征(ARDS)为主要特征入院,X线胸片示双肺大片实变影并进行性进展,入院至死亡不足3 d。中国疾病预防控制中心应用逆转录-聚合酶链反应(RT-PCR)、实时聚合酶链反应(real-tim e PCR)技术检测患者下呼吸道吸出物标本,发现禽流感病毒血凝素(HA)5型特异性基因片段呈阳性;尸检肉眼所见主要有支气管充血、双肺实变,多浆膜腔积液;弥漫性血管内凝血(D IC)及多脏器功能衰竭(MOF)。结论人感染高致病性H5N1亚型禽流感是一种致命的传染性疾病。提高认识,重视流行病学调查并及早干预是降低病死率的主要手段。
Objective To investigate the clinical characteristics and control measures of human highly pathogenic H5N1 subtype avian influenza. Methods In November 2005, 1 young female patient diagnosed as H5N1 subtype avian influenza was diagnosed, and its clinical manifestation, imaging and epidemiological characteristics were analyzed. Results The patient had close contact with dead poultry before onset and died from onset to about 10 d. Before the onset of dyspnea, the fever lasted for 5 days and was admitted to the hospital with acute community-acquired pneumonia and acute respiratory distress syndrome (ARDS) as the main characteristics. X-ray showed massive lung consolidation and progressive progression. Death less than 3 d. China Center for Disease Control and Prevention (CNTC) detected the specimens of lower respiratory tract aspirates from the patients by reverse transcription-polymerase chain reaction (RT-PCR) and real-time PCR (real-time PCR) 5 type-specific gene fragments were positive; autopsy gross findings of the main bronchial congestion, lung consolidation, multiple serous effusion; diffuse intravascular coagulation (DIC) and multiple organ failure (MOF). Conclusion Human infection with highly pathogenic H5N1 subtype of avian influenza is a deadly infectious disease. Awareness raising, emphasis on epidemiological investigations, and early intervention are the primary tools for reducing mortality.