中国大陆首例H5N1人禽流感肺炎报告

Report of the first human case of H5N1 avian influenza pneumonia in Human,China

目的总结2005年中国首例确诊并救治成功的人禽流感肺炎病例的临床特征、诊疗经验。方法分析我院收治抢救的中国大陆首例人禽流感肺炎病例的临床资料，总结其临床特点、诊疗体会。结果本例为9岁男孩，急性起病，但早期症状与普通呼吸道感染相似，早期症状轻，表现为发热、干咳，卡他症状不明显，容易被忽视而耽误治疗；5—7d进入进展期后，有进展快，肺部改变严重及血象白细胞低的特点。本例初期体温中度升高，能坚持上学；病程第7天病情加重，体温高，达40℃，精神差，伴气促，肺部湿啰音明显，胸片双肺呈现大片致密影，周围血象低，白细胞最低为2．81×10^9／L，分类以中性核粒细胞为主。给予抗病毒和糖皮质激素等综合治疗，体温在入院后第3天降至正常，胸片于第5天开始吸收，血白细胞于第6天恢复正常。未出现特殊并发症。在病程中早期禽流感病毒（H5N1）核酸检测阴性，通过恢复期血清抗体4倍升高而确诊。本例没有使用达菲，服用金刚烷胺、利巴韦林5d，同时采取抗感染和小剂量糖皮质激素3周等综合治疗痊愈出院。结论早期重视流行病学调查，可以达到人禽流感肺炎的早发现和早诊断，应用有效治疗可控制病情和改善预后。

Objective To summarize and analyze the clinical characteristics and diagnostic and therapeutic measures for the first human case of H5N1 avian influenza pneumonia in mainland of China. Methods The clinical data of the first case of H5N1 avian influenza virus infection in China were analyzed and summarized. Results The case is a 9-year old boy, who developed acute symptoms of a light common respiratory infection, including fever and dry cough without obvious catarrh. On the 7^th day after onset, his temperature reached 40℃, tachipnea occurred, distinct rales could be heard and large areas of consolidation were seen in the lungs on chest X-ray. The patient＇s peripheral blood leukocyte count was 2.81×10^9/L and neutrophils dominated. After comprehensive therapeutic approaches, including antiviral therapy （amantadine） and use of low-dosage glucocorticoid, the patient＇s temperature returned to normal on the 3^rd hospitalization day, chest X-ray showed absorbed inflammatory change on the 5^th day after admission, and leukocyte count became normal on the 6^th day. No complication occurred during the whole course. The case was diagnosed by the 4 fold raised antibody to the H5N1 influenza virus in recovery stage serum because the H5N1 nucleic acid test in early stage was negative. The case was cured and discharged after 3 weeks comprehensive treatment. Conclusions It is very important for clinicians to pay enough attention to epidemiological history, especially history of exposure to avian influenza virus contaminated material, which will be very helpful for early detection, early diagnosis of the disease, and also very important for effective treatment and better prognosis.