摘要
目的总结和分析湖南省人感染H7N9禽流感确诊病例的流行病学资料和临床特征,为该病的防控、诊治提供科学依据。方法收集湖南省2013年3月1日至2017年4月20日期间报告的人感染H7N9禽流感实验室确诊病例91例,除外年龄<18岁(n=2)及重要数据缺失(n=10)的患者,共79例H7N9患者纳入分析。总结该病的人口统计学资料、临床特点及抗病毒药物使用情况。结果湖南省内人感染H7N9禽流感发病集中在第二波和第五波,第五波中患病人数超过前4波总和,但流行病学特征、临床症状及病死率并无明显变化。第五波中抗病毒药物应用更积极,从发病到抗病毒药物使用时间比第二波短[(6.3±2.4)d比(7.6±2.4)d,P=0.047]。多因素Logistic回归分析显示休克是H7N9患者死亡的独立危险因素(OR=4.683,95%CI 1.136~19.301,P=0.033)。奥司他韦组、奥司他韦+帕拉米韦组、帕拉米韦组患者的病死率无显著差异。结论湖南省第五波人感染H7N9禽流感疫情较前扩散,但临床特征变化不大,抗病毒治疗应更加积极。休克是H7N9患者死亡的独立危险因素。奥司他韦和帕拉米韦联合抗病毒并不显著改善病死率。
Objective To analyze the clinical and epidemiological characteristics of hospitalized avian influenza A（H7 N9） virus infections in Hunan province from 2013 to 2017, and provide evidences for control, diagnosis and treatment of this disease. Methods Ninety-one hospitalized patients were confirmed with H7 N9 infection in Hunan.Excluding 2 patients less than 18 years old and 10 with missing data, 79 patients with H7 N9 infection were analyzed.Results Most confirmed cases were affected in the second and fifth epidemic wave and number of patients in the fifth wave was more than the sum in prior 4 waves. Epidemiological characteristics, clinical symptoms and case fatality did not change significantly. Administration of antiviral drugs was more active in the fifth wave [from illness onset to antiviral drug：（6.3±2.4）d vs.（7.6±2.4）d, P=0.047]. Multiple logistic regression analysis showed that shock（OR=4.683, 95%CI1.136–19.301, P=0.033） was the independent risk factor of H7 N9 infections. There were no significant differences in case fatality among group oseltamivir, group oseltamivir＋peramivir, and group peramivir. Conclusions Patients with avian influenza A（H7 N9） increased in the fifth wave but clinical characteristics changed little. Antiviral treatment should be more active. Shock is an independent risk factor of H7 N9 infections. Oseltamivir-peramivir biotherapy can not reduce case fatality compared with oseltamivir or peramivir monotherapy.
作者
易丽姗
胡成平
张恒娇
李再清
杨湘永
周永升
李炽观
贺喜强
YI Lishan;HU Chengping;ZHANG Hengjiao;LI Zaiqing;YANG Xiangyong;ZHOU Yongsheng;LI Chiguan;HE Xiqiang(Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China;Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan 410005, P. R. China;Department of Respiratory Medicine, Central Hospital of Shaoyang, Shaoyang, Hunan 422000, P. R. China;Department of Respiratory Medicine, Central Hospital of Yongzhou, Yongzhou, Hunan 425000, P. R. China;Department of Respiratory Medicine, Central Hospital of Loudi, Loudi, Hunan 422000, P. R. China;Department of Respiratory Medicine, Chenzhou No.1 People＇s Hospital, Chenzhou, Hunan 423000, P. R. China;Intensive Care Unit, Central Hospital of Xiangtan, Xiangtan, Hunan 411100, P. R. China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2018年第4期341-347,共7页
Chinese Journal of Respiratory and Critical Care Medicine
基金
湖南省卫生计生委科研计划课题项目(B2016074)
关键词
人感染H7N9禽流感
H7N9
禽流感
临床特征
抗病毒
Human infections with avian influenza A （H7N9） virus
H7N9
Avian influenza
Clinicalcharacteristics
Antivirus
