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据文献报道,禽流感病毒AH5N1亚型感染的死亡率仍然很高,现在WHO报道的数据是大约50%。事后分析发现,感染患者的噬血细胞现象与噬血细胞性淋巴组织增生症(HLH)患者相似。这种噬血细胞现象可能是H5N1感染后的一个显著特征。在临床表现方面,H5N1感染与HLH也有相似,比如血细胞减少以及急性脑炎。据报道,其他重症病毒感染且有可能并发继发性HLH、重症EB病毒相关噬血细胞性淋巴组织增生症(Epstein-Barrvirus-associatedhemophagocyticlymphohistiocytosis,EBV-H的LH)患者,若早期即开始给予特异性的HLH治疗(包括细胞毒药物和促进凋亡的药物),存活率会由50%升至90%。由于生存率有如此明显的升高,特异性的HLH治疗(包括细胞毒药物治疗)可被作为重症禽流感病毒A感染并发继发性HLH患者的治疗方法。
It has been reported in the literature that the mortality rate of avian influenza A virus subtype AH5N1 is still high, and the data now reported by the WHO is about 50%. Post hoc analysis found that hemophagocytosis in infected patients was similar to that in patients with hemophagocytic lymphohistiocytosis (HLH). This hemophagocytosis may be a significant feature of H5N1 infection. In clinical manifestations, H5N1 infection is similar to HLH, such as cytopenias and acute encephalitis. It has been reported that patients with other severe viral infections who are likely to develop secondary HLH and Epstein-Barrvirus-associated hemophagocyticlymphohistiocytosis (LH) of EBV-H are given specific early HLH treatment (including cytotoxic drugs and drugs that promote apoptosis), the survival rate from 50% to 90%. Due to this marked increase in survival rates, specific HLH therapy, including cytotoxic drug therapy, can be used as a treatment for patients with severe avian influenza A infection complicated by secondary HLH.