53例重症甲型H1N1流感临床分析

目的了解重症甲型H1N1流感的临床特点,探索其治疗方法。方法回顾性分析53例重症甲型H1N1流感患者的临床资料,总结其临床规律及特点。结果重症甲型H1N1流感好发于20～40岁,20例（37.74%）伴有各种基础疾病。51例（96.23%）有发热,且48例（90.57%）为首发症状,多伴随有畏寒、咳嗽、咳痰、乏力、胸闷和气急等症状。发病早期血常规检查白细胞及中性粒细胞多正常或下降;胸部影像学检查提示33例（62.26%）患者继发不同程度的支气管炎或肺炎。患者经奥司他韦或帕拉米韦抗病毒治疗及相应的抗感染、针对基础疾病治疗等,除2例患者自动出院外,余均痊愈出院。结论重症甲型H1N1流感起病急,早诊断、早期积极合理治疗,能改善预后。     

《柳叶刀》：H7N9死亡风险低于H5N1高于H1N1

中国科学家6月24日在线发表于《柳叶刀》上的研究论文称,H7N9禽流感患者死亡风险远低于人感染H5N1禽流感。但高于季节性流感和甲型H1N1流感。     

云南省2009～2014年甲型H1N1流感病毒HA及NA基因特征分析

了解云南省2009~2014年甲型H1N1流感病毒的流行趋势,研究HA和NA基因进化特征。对云南省近6年来上报的流感监测病例数据进行病原谱总结,挑选出23株甲型H1N1流感毒株进行HA及NA基因分析。利用MEGA 5.0软件对测序结果构建进化树分析基因同源性。2009~2014年云南省共监测到4次甲型H1N1流感流行高峰,核酸检测结果中甲型H1N1流感占检出总量的28.8%。测序结果显示,HA与NA基因均分为3个类群,检测到一株具有H275Y突变位点的毒株。甲型H1N1流感是导致本省流感流行的重要亚型之一,2009~2014年间分离的毒株主要有Goup1、Gourp7和Gourp6三个支系,绝大部分甲型H1N1流感毒株仍对神经氨酸酶抑制剂敏感。     

抗击甲型H1N1流感大流行第一线的中国企业

自2009年3月18日墨西哥发现人感染甲型H1N1病毒疑似病例以来,一种新的猪源性H1N1型流感病毒开始在墨西哥和美国蔓延开来．并在数周内扩散到很多国家和地区．不断引起人类感染和死亡。伴随着流感疫情在全球范围内的迅速蔓延,6月初,世界卫生组织宣布把甲型H1N1流感警戒级别升至6级．甲型H1N1流感疫情已经发展成为全球性“流感大流行”。甲型H1N1流感疫情成为了全球高度关注的突发公共卫生事件。     

中医成药治疗甲型H1N1 流感研究进展

近年来,中医药治疗甲型H1N1流感取得了较好的临床疗效。尽管目前临床对甲型H1N1流感的治疗仍以西药为主,但西药抗病毒药存在副作用大,易引起耐药性等缺点,限制了治疗的效果。中医治疗甲型H1N1流感则具有独特的思路,根据甲型H1N1流感不同进展阶段的不同证型,选择不同的中药进行"辨证论治",不仅能减轻西药的不良反应,而且在疾病的治疗上也有独特的功效。我们总结了近来学者们对中医成药治疗甲型H1N1流感的临床及基础研究,将甲型H1N1流感分为轻、中、重三种,并分别根据症状与中医证型相匹配,梳理了临床用于治疗甲型H1N1流感的中医成药的适应证型与作用机制。因此,在西药进行抗病毒治疗的同时,根据疾病进展不同阶段的中医的证型,选用不同的中医方药,可有效减少西药的不良反应,取得更好的疗效。     

中国内地首例确诊甲型H1N1流感病例的实验室检测

本实验室针对中国四川省一例输入性疑似甲型H1N1流感病例的临床咽拭子标本进行Real-time PCR和RT-PCR检测,并随后对部分基因片段进行测序,结果表明临床咽拭子标本为甲型H1N1流感病毒阳性,因此该疑似甲型H1N1流感病例成为中国内地首例确诊的甲型H1N1流感病例。     

甲型H1N1流感病毒血凝素蛋白单抗杂交瘤细胞株的制备与初步鉴定

目的:建立具有高特异、高效价的甲型H1N1流感病毒血凝素蛋白(HA)单抗的杂交瘤细胞株。方法:以纯化的昆虫杆状病毒表达的甲型H1N1流感病毒HA蛋白为免疫原免疫BALB/c小鼠,取脾细胞与Sp2/0小鼠骨髓瘤细胞融合,通过有限稀释法筛选阳性克隆,经ELISA和Western blot分析单抗的特性和特异性。结果:获得6株甲型H1N1流感HA抗原特异单克隆抗体杂交瘤细胞株,抗原肽库ELISA检测结果表明其中3株(1E12,3F12,1C11)单抗只与甲型H1N1流感HA抗原肽库反应,不与H5N1病毒HA抗原肽库反应;Western blot分析表明,单抗1B3只特异识别甲型H1N1流感HA抗原,而与其他季节性甲流病毒(H1,H3)及人禽流感H5N1病毒不反应。结论:所获杂交瘤细胞株特异性强,效价高,分泌抗体性能稳定,为分析甲型H1N1流感病毒抗原性位点、建立诊断试剂奠定了基础。     

我国首例孕妇感染高致病性禽流感(H5N1)的病原学研究

对2005年11月8日安徽省铜陵市人民医院报告的一例孕妇不明原因肺炎病例的死亡病因进行研究。采集病人的气管吸出物及血液标本,用RT-PCR和Real-ti me PCR方法检测流感病毒A/M、A/H5N1、A/H7N7、A/H9N1亚型特异性核苷酸片段;气管吸出物接种SPF鸡胚进行病毒分离,并对分离物进行鉴定和序列测定及分析;利用血凝抑制试验检测血清标本抗体。结果表明病人气管吸出物可以检测到甲型流感病毒M片段及H5亚型的特异性HA基因。2005年11月9日采集的血清标本用Real-ti me PCR检测到甲型流感病毒M基因。从病人的气管吸出物中分离到H5N1病毒(A/Anhui/1/2005),对病毒的HA基因序列结果进行分析表明病毒是禽源的,其主要依据是受体结合位点第226~228位氨基酸位点(QSG)为禽流感病毒所特异,HA受体连接肽仍为9个碱性氨基酸(LRERRRKRP);基因进化树分析显示,HA基因与禽源病毒进化距离接近。发病后7、8、9d的血清H5N1禽流感病毒HI抗体小于20。对该病例的病原学研究证明,该病例为H5N1禽流感感染病例。     

湖南省2009～2011年甲型H1N1流感哨点监测病原学结果及病毒基因特性分析

了解和掌握2009～2011年湖南省甲型H1N1流感流行动态和变化规律,掌握甲型H1N1流感流行株基因特性及耐药性情况。收集哨点医院采集的流感样病例咽拭子标本,通过荧光PCR法或病毒分离法对流感病毒进行检测,选取部分阳性毒株进行基因序列测定,序列使用MEGA 5.05软件完成进化分析。2009年第20周至2011年52周,共检测标本17 773份,检出流感阳性标本3 831份,检测阳性率为21.6%,其中甲型H1N1流感阳性标本1794份,占流感阳性的比例为46.8%。甲型H1N1流感共有2个流行高峰,分别出现在2009年第41～53周和2011年第1～12周。测序的23株毒株HA基因亲缘关系较近,病毒在基因进化树中基本上按照时间顺序分布。全基因组序列分析显示7株毒株的所有8个基因片段均与疫苗株同源,并未发现基因重配。23株毒株的HA氨基酸位点相对于疫苗株高度相似(同源性为98.2%～100%),但均有P83S、S203T和I321V的突变。在A/Hunan/YQ30/2009毒株中发现了可能导致病毒毒力增强的222位点突变,突变为D222E。所有检出毒株均未发现对奥斯他韦耐药性的突变。2009～2011年湖南省甲型H1N1流感流行呈双峰分布,未发现病毒基因发生大规模变异,临床上使用奥斯他韦仍然是有效的。     

2009甲型H1N1流感病毒研究进展

2009年3月在美国和墨西哥爆发的新型甲型H1N1流感在很短的时间内便扩散到世界多个国家,形成了流感的大流行,引起世界卫生组织和各国的高度重视。综述新型甲型H1N1流感病毒的基因组来源、目前主要的检测手段,并对预防和治疗的方法进行简单介绍。     

Influenza A: From highly pathogenic H5N1 to pandemic 2009 H1N1. Epidemiology and clinical features

The last decade has seen the emergence of two new influenza A subtypes and they have become a cause of concern for the global community. These are the highly pathogenic H5N1 influenza A virus (H5N1) and the Pandemic 2009 influenza H1N1 virus. Since 2003 the H5N1 virus has caused widespread disease and death in poultry, mainly in south East Asia and Africa. In humans the number of cases infected with this virus is few but the mortality has been about 60%. Most patients have presented with severe pneumonia and acute respiratory distress syndrome. The second influenza virus, the pandemic H1N1 2009, emerged in Mexico in March this year. This virus acquired the ability for sustained human to human spread and within a few months spread throughout the world and infected over 4 lakh individuals. The symptoms of infection with this virus are similar to seasonal influenza but it currently affecting younger individuals more often. Fortunately the mortality has been low. Both these new influenza viruses are currently circulating and have different clinical and epidemiological characteristics.     

Severe Human Influenza Infections in Thailand: Oseltamivir Treatment and Risk Factors for Fatal Outcome

Background

Influenza is often not recognized as an important cause of severe or fatal disease in tropical and subtropical countries in Southeast Asia. The extent to which Oseltamivir treatment may protect against a fatal outcome in severe influenza infections is not known. Thailand''s National Avian Influenza Surveillance (NAIS) system affords a unique opportunity to describe the epidemiology of laboratory-confirmed severe and fatal human influenza infections.

Methodology/Principal Findings

During January 2004 through December 2006, 11,641 notifications to the NAIS were investigated in 73 of 76 Thai provinces. Clinical and demographic data and respiratory swab specimens were collected and tested by PCR for influenza. Using the NAIS database, we identified all patients with laboratory confirmed human influenza (A/H3N2, A/H1N1 and Type B) infection. A retrospective medical record review was conducted on all fatal cases with laboratory confirmed influenza and from a sample of hospitalized cases in 28 provinces. The association of underlying risk factors, Oseltamivir treatment and risk of a fatal outcome were examined. Human influenza infections were identified in 2,075 (18%) cases. Twenty-two (1%) deaths occurred including seven deaths in children less than ten years of age. Thirty-five percent of hospitalized human influenza infections had chest X-ray confirmed pneumonia. Current or former smoking; advanced age, hypertension and underlying cardiovascular, pulmonary or endocrine disease were associated with a fatal outcome from human influenza infection. Treatment with Oseltamivir was statistically associated with survival with a crude OR of .11 (95% CI: 0.04–0.30) and .13 (95% CI: 0.04–0.40) after controlling for age.

Conclusions

Severe and fatal human influenza infections were commonly identified in the NAIS designed to identify avian A/H5N1 cases. Treatment with Oseltamivir is associated with survival in hospitalized human influenza pneumonia patients.     

Increased levels of cytokines and high-mobility group box 1 are associated with the development of severe pneumonia, but not acute encephalopathy, in 2009 H1N1 influenza-infected children

Background

The 2009 A(H1N1) influenza virus has caused a large outbreak, and resulted in major complications of severe pneumonia and acute encephalopathy in the pediatric population in Japan.

Methods

This study examined six patients with acute encephalopathy, 34 patients with severe pneumonia, five patients with both pneumonia and encephalopathy, and 46 patients without severe complications. The concentrations of 27 cytokines were examined in the cerebrospinal fluid of patients with encephalopathy, and the levels of these cytokines, Cytochrome c, high-mobility group box 1 (HMGB1) were measured in the serum of all patients.

Results

Patients with severe pneumonia had higher serum concentrations of 16 cytokines, including Th1 cytokines, Th2 cytokines, chemokines, and growth factors, than patients with uncomplicated influenza. The distribution of 27 cytokines in the CSF did not parallel the serum levels in 11 patients with acute encephalopathy. HMGB1 concentrations in the serum were significantly higher in pneumonia patients with or without encephalopathy than in uncomplicated influenza patients, and were significantly associated with the upregulation of 10 cytokines.

Conclusions

Elevated levels of Th2 cytokines appear to be unique to influenza caused by 2009 H1N1 influenza virus and HMGB1 could play an important role in the pathogenesis of severe pneumonia. There appear to be different pathologic processes for encephalopathy and pneumonia.     

Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia

Avian influenza A (H5N1) viruses cause severe disease in humans, but the basis for their virulence remains unclear. In vitro and animal studies indicate that high and disseminated viral replication is important for disease pathogenesis. Laboratory experiments suggest that virus-induced cytokine dysregulation may contribute to disease severity. To assess the relevance of these findings for human disease, we performed virological and immunological studies in 18 individuals with H5N1 and 8 individuals infected with human influenza virus subtypes. Influenza H5N1 infection in humans is characterized by high pharyngeal virus loads and frequent detection of viral RNA in rectum and blood. Viral RNA in blood was present only in fatal H5N1 cases and was associated with higher pharyngeal viral loads. We observed low peripheral blood T-lymphocyte counts and high chemokine and cytokine levels in H5N1-infected individuals, particularly in those who died, and these correlated with pharyngeal viral loads. Genetic characterization of H5N1 viruses revealed mutations in the viral polymerase complex associated with mammalian adaptation and virulence. Our observations indicate that high viral load, and the resulting intense inflammatory responses, are central to influenza H5N1 pathogenesis. The focus of clinical management should be on preventing this intense cytokine response, by early diagnosis and effective antiviral treatment.     

Antiviral role of toll-like receptors and cytokines against the new 2009 H1N1 virus infection

People are generally susceptible to the 2009 new mutate of H1N1 influenza due to lack of appropriate immunity. Influenza H1N1 2009 infection triggers a massive inflammatory response that contributes to fever, lung impairment or other tissue damage, eventually leading to death. Infection with pathogenic influenza virus H1N1 induces severe pulmonary immune pathology. To date, more than 10,000 cases worldwide have died of the disease. It still has strong infectious ability although the mortality of influenza isn’t currently high. Therefore, to explore the pathogenesis of H1N1 influenza can help with the disease prevention, diagnosis and provide a theoretical basis and the new ideas of treatment. Laboratory confirmed cases of pandemic influenza H1N1 2009 were enrolled to collect general information on pre-clinical, clinical and laboratory data for analysis. Blood samples were obtained from patients with H1N1, healthy volunteers and patients with bacterial pneumonia. Serum were separated and collected. RT–PCR and ELISA methods were applied to detect the different expression of TLRs and cytokines. The young, pregnant and postpartum women and infant are highly susceptible to influenza H1N1 2009 infection; degree of susceptibility is not associated with BMI. Biochemical changes can be seen in the patients with influenza H1N1 2009 infection: ALT, AST, CK, LDH increased in varying degrees. TLR2, TLR3, TLR9 expression increased in the patients with influenza H1N1 2009 infection; no obvious changes of TLR4, TLR7, TLR8 can be detected. In pregnant and postpartum women group, only TLR9 expression increased. The expression of IL-2, IL-6, IFN-γ, TNF-α in the patients with influenza H1N1 2009 infection was significantly increased; while IL-10 expression decreased and IL-4 expression did not change. H1N1 influenza-infected pregnant and postpartum women group, only IL-2 and TNF-α expression expression increased, other cytokines decreased or didn’t change. TLR2, TLR3, TLR9 are the major members of TLR family in the recognition of the novel H1N1 virus to start the innate immune response and adaptive immune responses. TLR9 may be the key receptor among pattern recognized receptors to recognize and bind to H1N1 virus. Cellular immune responses induced by Th1 may participate in modulating the influenza H1N1 2009.     

Risk of severe outcomes among patients admitted to hospital with pandemic (H1N1) influenza

Background

We describe the disease characteristics and outcomes, including risk factors for admission to intensive care unit (ICU) and death, of all patients in Canada admitted to hospital with pandemic (H1N1) influenza during the first five months of the pandemic.

Methods

We obtained data for all patients admitted to hospital with laboratory-confirmed pandemic (H1N1) influenza reported to the Public Health Agency of Canada from Apr. 26 to Sept. 26, 2009. We compared inpatients who had nonsevere disease with those who had severe disease, as indicated by admission to ICU or death.

Results

A total of 1479 patients were admitted to hospital with confirmed pandemic (H1N1) influenza during the study period. Of these, 1171 (79.2%) did not have a severe outcome, 236 (16.0%) were admitted to ICU and survived, and 72 (4.9%) died. The median age was 23 years for all of the patients, 18 years for those with a nonsevere outcome, 34 years for those admitted to ICU who survived and 51 years for those who died. The risk of a severe outcome was elevated among those who had an underlying medical condition and those 20 years of age and older. A delay of one day in the median time between the onset of symptoms and admission to hospital increased the risk of death by 5.5%. The risk of a severe outcome remained relatively constant over the five-month period.

Interpretation

The population-based incidence of admission to hospital with laboratory-confirmed pandemic (H1N1) influenza was low in the first five months of the pandemic in Canada. The risk of a severe outcome was associated with the presence of one or more underlying medical conditions, age of 20 years or more and a delay in hospital admission.The first cases of pandemic (H1N1) influenza in Canada were reported on Apr. 26, 2009. Retrospective case-finding determined that the onset of symptoms in the first Canadian case, involving a traveller returning from Mexico, occurred on Apr. 12, 2009. The first patient admitted to hospital began to experience symptoms on Apr. 18.During the first few weeks of the outbreak, in-depth follow-up and reporting of cases was conducted in keeping with the World Health Organization’s pandemic plans for each country to comprehensively assess its first 100 cases.¹ By mid-May, many Canadian jurisdictions moved away from this approach because it became increasingly taxing on both public health human resources and laboratory capacity. It was decided that reporting of individual cases would continue nationally only for patients who were admitted to hospital or who died. We provide a detailed review of the disease characteristics and outcomes, including risk factors for admission to intensive care unit (ICU) and death, of patients admitted to hospital in Canada during the first five months of the pandemic.     

Pandemic Influenza (H1N1) 2009 Pneumonia: CURB-65 Score for Predicting Severity and Nasopharyngeal Sampling for Diagnosis Are Unreliable

Background

From the first case reports of pandemic influenza (H1N1) 2009 it was clear that a significant proportion of infected individuals suffered a primary viral pneumonia. The objective of this study was twofold; to assess the utility of the CURB-65 community acquired pneumonia (CAP) severity index in predicting pneumonia severity and ICU admission, and to assess the relative sensitivity of nasopharyngeal versus lower respiratory tract sampling for the detection of pandemic influenza (H1N1) CAP.

Methods

A retrospective cohort study of 70 patients hospitalised for pandemic influenza (H1N1) 2009 in an adult tertiary referral hospital. Characteristics evaluated included age, pregnancy status, sex, respiratory signs and symptoms, smoking and alcohol history, CURB-65 score, co-morbidities, disabling sequelae, length of stay and in-hospital mortality outcomes. Laboratory features evaluated included lymphocyte count, C-reactive protein (CRP), nasopharyngeal and lower respiratory tract pandemic influenza (H1N1) 2009 PCR results.

Results

Patients with pandemic (H1N1) 2009 influenza CAP differed significantly from those without pneumonia regarding length of stay, need for ICU admission, CRP and the likelihood of disabling sequelae. The CURB-65 score did not predict CAP severity or the need for ICU admission (only 2/11 patients admitted to ICU had CURB-65 scores of 2 or 3). Nasopharyngeal specimens for PCR were only 62.9% sensitive in CAP patients compared to 97.8% sensitivity for lower respiratory tract specimens.

Conclusions

The CURB-65 score does not predict severe pandemic influenza (H1N1) 2009 CAP or need for ICU admission. Lower respiratory tract specimens should be collected when pandemic (H1N1) 2009 influenza CAP is suspected.     

禽流感H5N1亚型病毒对五个不同品系小鼠致病性的比较(英文)

目的比较了不同遗传背景小鼠对禽流感H5N1亚型病毒的致病敏感性,为H5N1禽流感模型制作和机理研究提供依据。方法近交系BALB/c、C57BL/6和封闭群ICR、NIHSwiss和KMSwiss共五个不同品系小鼠。每个品系实验动物30只,分接毒组20只,空白对照组10只,每组雌雄各半。病毒株为A/Goose/Guangdong/NH/2003(H5N1),经测定TCID50为10-4.875/mL。接毒组通过鼻腔接种0.1mL病毒液,对照组接种正常鸡胚尿囊液。小鼠接毒后连续观察14d,观察记录临床症状、体温、体重变化,对在实验期间死亡和实验14d结束后仍然存活的小鼠均进行组织器官病理取材,进行RT-PCR病毒分离检测、HE染色及H5N1抗原特异性免疫组化染色。结果①临床症状:H5N1禽流感病毒能感染五个品系的小鼠,引起呼吸急促等症状和一过性体重、体温下降。②死亡情况:小鼠在接毒后第1天即出现死亡,死亡的高峰期集中在接毒后第3～6天。五个品系小鼠死亡率存在差异,BALB/c为70%,ICR为50%,NIHSwiss为40%,C57BL/6为25%,KMSwiss为10%;③病毒分离:各组接毒小鼠在死亡后均进行了病毒分离,死亡小鼠的肺脏均分离到病毒,其他脏器未分离到病毒。④病理变化:实验期间五个品系死亡小鼠肺脏病理改变相近。大体观:死亡小鼠肺部淤血,呈暗红色,体积增大,局部肺组织实变。镜下观:死亡小鼠的共同病理改变为间质性肺炎,具体表现为肺泡腔及间质出血、炎性细胞浸润;间质增生,肺泡隔增宽;肺泡腔中见纤维素性渗出,透明膜形成。⑤免疫组化结果 :在死亡小鼠的气管上皮细胞和肺巨噬细胞可观察到H5N1禽流感病毒阳性表达。结论小鼠作为H5N1禽流感病毒模型具有普适性,不同品系小鼠感染鹅源H5N1禽流感病毒的临床症状、病程和病理变化与人禽流感病例相似。不同品系小鼠的死亡比例有明显差别,可以根据不同的实验目的 ,选择不同品系的小鼠制作H5N1禽流感动物模型。不同品系的遗传特性对禽流感易感性产生明显的影响,遗传背景可能与H5N1禽流感病毒感染应答机理存在联系:BALB/c和C57BL/6均为近交系,其中BALB/c小鼠的品系特征之一表现为干扰素产量低,接种H5N1病毒后表现为高死亡率(70%),而C57BL/6小鼠的干扰素产量高,接种H5N1病毒后表现为低死亡率(25%),提示不同遗传背景小鼠的干扰素水平与H5N1感染致死具相关性。为进一步研究H5N1禽流感病毒易感性相关基因以及其与宿主免疫反应的关系提供了一个研究基础。