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目的分析人感染H7N9禽流感重症病例临床特征,为临床诊断和治疗提供依据。方法回顾性分析绍兴市中心医院收治的3例人感染H7N9禽流感重症病例的临床特征,并采集患者呼吸道分泌物,进行禽流感病毒核酸检测。结果 3例病例以发热、咳嗽或消化道症状起病,主要表现为咳嗽、咯痰等呼吸道症状或有呕吐、腹泻等消化道症状;均有发热,最高体温40.0℃,用非甾体抗炎镇痛药后体温短暂下降,但数小时后体温回升,持续高热8~10 d,热程第5~9 d内进展为呼吸困难合并急性呼吸窘迫综合征(ARDS)。实验室检测显示,白细胞计数正常或稍降低,淋巴细胞下降明显;乳酸脱氢酶、天门冬氨酸氨基转移酶、超敏C反应蛋白、D-二聚体随疾病进展进行性升高;H7N9禽流感病毒核酸PCR均呈阳性。发病初,3例病例肺部听诊均未现明显阳性体征,胸部影像学表现为片状高密度影,内见空气支气管征,单侧肺或双侧肺感染起病,48 h内迅速发展为双侧肺感染并伴胸腔积液,均为肺部实变。流行病学调查显示1例有明确的活禽接触史。最终治愈1例,死亡2例。结论人感染H7N9禽流感病例临床特征不典型,肺部病变进展快,死亡率高,在冬春季应高度重视不明原因肺炎。
Objective To analyze the clinical characteristics of severe cases of human avian influenza H7N9 infection and provide the basis for clinical diagnosis and treatment. Methods The clinical features of 3 severe cases of H7N9 avian influenza in humans admitted to Shaoxing Central Hospital were analyzed retrospectively. The respiratory secretions of patients were collected for the detection of avian influenza virus nucleic acid. Results The 3 cases had fever, cough or gastrointestinal symptoms. The main symptoms were respiratory symptoms such as cough and expectoration, digestive symptoms such as vomiting and diarrhea. All had fever, the highest body temperature was 40.0 ℃, and the non-steroidal anti-inflammatory After a brief period of hypothermia, the body temperature of the analgesic decreased temporarily, but after a few hours, the body temperature rose and continued to have a fever of 8-10 d. The ARD progressed from dyspnea to complication of ARDS in 5-9 d of the heat stroke. Laboratory tests showed that the white blood cell count was normal or slightly decreased, lymphocytes decreased significantly; lactate dehydrogenase, aspartate aminotransferase, high-sensitivity C-reactive protein, D-dimer increased progressively with the disease progression; H7N9 Avian influenza virus nucleic acid PCR were positive. Early onset, three cases of pulmonary auscultation were no significant positive signs, chest radiograph showed flaky high-density, see the air bronchial signs, unilateral or bilateral lung infection onset, rapid development within 48 h Bilateral lung infection and pleural effusion, are lung consolidation. Epidemiological survey showed a clear history of live poultry exposure. The final cure in 1 case, 2 patients died. Conclusion The clinical characteristics of human H7N9 bird flu are not typical, the lung disease progresses rapidly and the mortality rate is high. In the winter and spring, pneumonia of unknown cause should be highly valued.