【摘要】 目的探讨2005年11月安徽省铜陵市人民医院报告的一例不明原因肺炎孕妇死亡的病因。方法访谈病例发病前后的相关知情人,查阅临床病志,对病例和病死禽的密切接触者进行医学观察。采集病例的气管吸取物,应用逆转录-聚合酶链反应(RT-PCR)和实时荧光定量PCR法,检测A/H5N1亚型特异的核酸片段,接种SPF鸡胚进行病毒分离。结果病例发病前4天有明确的病死禽直接暴露史,病例和病死禽的122名密切接触者经10天医学观察均健康。病毒性肺炎伴血白细胞和淋巴细胞计数的显著下降,迅速进展的呼吸衰竭和多器官衰竭是其主要临床特征。病例的气管吸取物A/H5N1的HA和NA基因阳性,分离到的A/Anhui/1/2005(H5N1)的8个基因节段均为禽源的,血凝素抗原的受体链接肽仍为多个碱性氨基酸。结论该病例为首次报告感染禽流感病毒 (H5N1)发病、死亡的孕妇。孕妇妊娠期间的免疫耐受状态可能是导致其感染,引起相应临床表现和进程的重要原因。更多还原

【Abstract】 Objective To ascertain the causation of a pregnant woman with undefined pneumonia reported from the People’ s Hospital of Tongling city in Anhui province on November 2005. Methods Epidemiological and clinical information of the case was collected from the keypersons close to the case and referring to the medical record. A medical observation was carried out on the close contacts of the case and sick or dead poultry. Tracheal aspirates being collected were tested by both RT-PCR and real-time PCR to detect viral nucleic acids of A/H5N1, and were inoculated into special pathogen free(SPF) embryonated hens’ eggs. Results The pregnant woman was found to have been contacted with the sick/dead poultry directly on the 4th day before onset of illness. All the 122 close contacts were healthy after a 10-day medical observation. The major clinical features of the case were viral pneumonia with rapidly developed leukopenia and lymphopenia. The progress to acute respiratory distress syndrome and multiple organ dysfunction syndromes was found at clinical presentation. HA and NA gene of A/H5N1 virus were positive. The 8 gene fragments of A/Anhui/1/2005 (H5N1) isolated from the tracheal aspirates had not carried genes from a human virus through reassortment, and the receptor-binding site of the hemagglutinin was polybasic cleavage site. Conclusion This was the first documented case of H5N1 infection in pregnant woman. The immunotolerant state of pregnancy might have predisposed to the fatal outcome of the patient.更多还原