从埃博拉出血热到埃博拉病毒病:更新认识、科学救治

From Ebola haemorrhagic fever to Ebola virus disease: new knowledge and scientific rescue

埃博拉病毒病(Ebola virus disease,EVD)在非洲流行已近40年,2014年3月开始的在西非三国大暴发流行是最严重的1次,截至2015年1月14日西非三国确诊病例为13 427例,其中塞拉利昂和几内亚病死率为41.03%(4 226/10 300)。同时大量病例的积累也丰富了我们对EVD的认识。中国人民解放军援利医疗队在利比里亚埃博拉治疗中心(Ebola Treatment Center,ETC)工作2个月,对EVD有了感性认识,发现目前治疗存在诸多困难,提出了病情轻重程度的分型标准及以疾病进展速度为依据分为"快速进展型"和"平稳型"的观点。后者有利于预后判断和及时施治。结合文献资料对未来防治EVD提出几点建议:在高流行国家建立具备临床检验实验室的长久性ETC,加强病理研究,提高床旁快速检验能力,加强生命支持,研制特殊专用设备,改进个人防护装备及研发无害、高效消毒剂等。

Ebola virus disease（ EVD） was firstly reported almost 40 years ago in Africa. Since March2014,a most widespread epidemic of EVD in history has been ongoing in several West African countries. Till this moment（ January 14,2015）,a total of 13 427 confirmed cases have been notified,with a mortality of41. 03%（ 4 226 /10 300） in Sierra Leone and Guinea. Meanwhile,numerous cases expand our understanding on EVD. The medical contingent of the Chinese PLA to Liberia established the China Ebola Treatment Center（ ETC） has operated there for 2 months,and thus we obtained perceptual knowledge of EVD. However,we found that there are still many difficulties in the current treatment. We proposed a new classification criterion according to the severity of the disease,and divided EVD into 2 types based on its progression,that is,rapid progress EVD and stable EVD. This classification based on progression is very helpful for the treatment of EVD. Combined with published literature,we also give a few suggestions on how to prevent and treat EVD in the future,such as,setting up permanent ETC with standard clinical laboratory in high prevalence countries,strengthening pathological studies,promoting rapid bedside test,enhancing life support therapy,developing special equipments,improving personal protective equipment（ PPE） and developing harmless disinfectants,etc.