【摘要】 目的分析人感染H7N9禽流感确诊死亡病例的临床及影像学特征,提高对重症病例诊治的认识。方法收集2016年12月-2017年1月苏州大学附属第三医院确诊的人感染H7N9禽流感死亡病例,回顾性分析其临床资料和影像学特征。结果 5例人感染H7N9禽流感确诊死亡病例中,中位年龄48.0岁,2例患者有基础疾病,2例患者有明确的接触活禽史;首发症状主要有发热、咳嗽,其次为咳痰和气促;5例患者均有氧合指数和外周血淋巴细胞计数的下降,CURB-65(C:意识障碍,U:尿素氮,R:呼吸,B:血压,65:年龄)评分和肺炎严重指数(pneumonia severity index,PSI)评分均为低危;所有患者均有C-反应蛋白、降钙素原、乳酸脱氢酶、肌酸激酶、肌红蛋白的升高;后期有1例患者从痰中分离到了鲍氏不动杆菌和大肠埃希菌,1例患者从痰中分离到了鲍氏不动杆菌;胸部影像学检查均表现为磨玻璃影和(或)实变影,2例患者后期出现胸腔积液;5例患者均在入院后48h内接受抗病毒治疗;5例患者均有严重并发症,其中并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、感染性休克、多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)、肝功能异常、血小板减少、气胸。结论人感染H7N9禽流感重症患者病情进展快,病死率高,短期内进展为ARDS,易并发急性肝损伤及合并细菌感染。更多还原

【Abstract】 OBJECTIVE To investigate the clinical and imaging characteristics of death cases with H7 N9 avian influenza,and to improve the understanding of the diagnosis and treatment of severe cases.METHODS We reviewed 5 death cases with avian influenza occurred in the Third Affiliated Hospital of Soochow University from Dec.2016 to Jan.2017.The clinical and imaging characteristics were retrospectively analyzed.RESULTS Of the 5 patients we studied,the median age was 48.0 years,2 patients had underlying diseases and 2 patients had a clear contact history with live poultry.Fever and cough were the most common presenting symptoms,followed by expectoration and shortness of breath.The PO2/FiO2 and the peripheral blood lymphocyte counts were decreased in all five cases.The CURB-65 score and PSI score of patients belonged to low-risk group.Elevated levels of C-reactive protein,procalcitonin,lactate dehydrogenase,creatine kinase and myoglobin were observed in all the patients.Acinetobacter baumannii and Escherichia coli were isolated from the sputum of 1 patient.Acinetobacter baumannii was also isolated from the sputum of another patient.The glazing and(or)real shadow were the most common radiologic findings.Pleural effussion occurred in 2 patients.All patients received antiretroviral therapy within 48 hours of admission.And all patients had severe complications,including ARDS,septic shock,MODS,abnormal liver function,thrombocytopenia and pneumothorax.CONCLUSION Human infection of H7 N9 avian influenza is featured by fast disease progression and high mortality rate,and often cause severe illness in patients including ARDS,abnormal liver function and bacterial infection.更多还原