人感染H7N9禽流感临床病理学特征分析

Analysis of clinicopathological features of patients infected with H7N9 avian influenza

目的探讨人感染高致病H7N9禽流感的临床病理学特征。方法收集12例人感染高致病H7N9禽流感患者的临床资料,其中3例有病理资料,分析其流行病学及病理学特征。结果流行病学统计显示H7N9禽流感最常见的症状为发热、咳嗽、咳痰、气促,伴全身酸痛、乏力等。血常规示白细胞计数正常或下降,淋巴细胞计数及比例下降,合并感染者白细胞计数和(或)中性粒细胞百分比升高;血气分析提示严重低氧血症、呼吸衰竭等。胸部影像学检查表现为双肺弥漫性斑片状、磨玻璃影及肺实变影且进展迅速。3例病理学显示:例1,左主气管赘生物纤支镜活检:形态学符合坏死性气管炎;例2,右下肺纤支镜活检:提示肺部急性感染性病变;例3,因气胸在体外膜氧合(ECMO)辅助通气胸腔镜下(VATS)行右肺大疱修补术,病理检查结果提示弥漫性肺泡损伤合并肺大疱。结论人感染H7N9禽流感的流行病学表现为病情进展迅速、凶险,临床表现为重症肺炎、多脏器功能衰竭等;针对具有疑似症状的患者,相关的临床检查及病理组织活检对该病诊断与鉴别诊断具有重要意义。

Purpose To investigate the clinicopathological features of patients with infection of highly pathogenic H7N9 avian influen- za. Methods Clinic data from 12 cases of patients diagnosed as infection of highly pathogenic H7N9 avian flu were collected, inclu- ding pathological information of 3 cases, from Fuzhou pulmonary hospital, Fujian province. Epidemiological characteristics arid clinico- pathological features were analyzed. Results Epidemiological data showed that the most common symptoms of H7N9 cases were fever, cough, sputum, shortness of breath, accompanied by body aches, fatigue and other clinical manifestations. Lab tests indicated white blood cell count was normal or decreased, lymphocyte count and proportion were declinded, white blood cell count and/or the percent- age of neutmphils were high in patients with coinfection bacteria, blood gas analysis showed severe hypoxemia, respiratory failure. Chest radiographic examination showed diffuse lung patchy ground glass pulmonary opacities and rapid progress. Three patients were performed with lung tissue biopsy. Case 1 was consistented with necrotizing bronchitis of morphology by left main pipe vegetation bron- choscopy biopsy. Case 2 was diagnosed as acute infectious lung disease by right lower lung bronchoscopy biopsy. Case 3 showed diffuse alveolar damage with pulmonary bullae by ventilation thoracoscopic （VATS） bullous lung repair of pneumothorax in ECMO. Conclu- sion Human infection with H7N9 avian flu showed dangerous disease and rapid progression. For patients with a suspected epidemic symptoms, clinical test assisted pathological biopsy has significance in diagnosis and differential diagnosis.