人感染H7N9禽流感20例临床特点及预后分析

The clinical characteristics and prognosis of 20 patients with H7N9 avian influenza

目的分析人感染H7N9禽流感患者的临床特点及与预后的关系.方法收集2016年12月至2017年3月南昌大学第一附属医院收治的20例人感染H7N9禽流感患者的发病特点、临床表现、治疗方案、实验室及影像学检查结果,并分析与预后的关系.根据最终临床结局分为死亡组与生存组.死亡组10例均死亡,生存组10例均出院.本研究结果呈正态分布的数据采用t检验,非正态分布的数据采用Wilcoxon秩和检验.结果 20例中,男13例,女7例,年龄40-82岁,平均(60±12)岁,其中12例有明确的禽类暴露史,10例有高血压、糖尿病等慢性基础疾病.20例患者临床表现主要为发热、咳嗽、咳痰、咯血、呼吸窘迫、乏力等.生存组血小板计数平均值为(167-315)×10^9/L,死亡组血小板计数平均值为(78-152)×10^9/L;生存组白细胞计数平均值为(7.78-11.52)×10^9/L,死亡组白细胞计数平均值为(9.91-15.93)×10^9/L;生存组淋巴细胞计数平均值为(0.69-1.59)×10^9/L,死亡组淋巴细胞计数平均值为(0.58-0.86)×10^9/L;死亡组丙氨酸氨基转移酶(ALT)为14.0-352.0 U/L;总胆红素为6.9-34.5 μmol/L;肌酸激酶同工酶MB(CK-MB)为16.0-162.0 U/L;血钙为1.4-2.0 mmol/L;C反应蛋白为33.1-414.0 mg/L;降钙素原为0.6-100.0 μg/L.生存组ALT为25.0-181.0 U/L,总胆红素为4.8-25.9 μmol/L, CK-MB为15.0-40.0 U/L,血钙为1.9-2.4 mmol/L,C反应蛋白为12.8-52.5 mg/L,降钙素原为0.3-23.3 μg/L.重症肺炎16例.20例中行体外膜肺氧合(ECMO)治疗12例,死亡组8例,生存组4例,8例死亡(均为死亡组),死亡原因主要与年纪、慢性基础性疾病及病情严重程度等因素有关.结论人感染H7N9禽流感病毒的致病性强,病死率高,易发展为重症肺炎;血小板计数明显降低的患者预后不佳.

Objective To analyzed the clinical characteristics and prognosis of patients with H7N9 avian influenza. Methods The baseline characteristics, clinical manifestations, treatments, laboratory and imaging findings were collected and analyzed for 20 patients with H7N9 avian influenza admitted to the First Affiliated Hospital of Nanchang University from December 2016 to March 2017. According to the final clinical outcome, the patients were divided into the death group and the survival group. Ten patients in the death group died, and 10 patients in the survival group were discharged. The data with normal distribution were analyzed by t test. The data with non-normal distribution were analyzed by Wilcoxon rank sum test. Results Of the 20 patients, 13 were males and 7 were females, aging 40-82 years, with a mean age of (60 ± 12) years. Twelve patients had a definite history of poultry exposure and 10 had chronic underlying diseases such as hypertension and diabetes. The clinical manifestations were mainly fever, cough, hemoptysis, respiratory distress, fatigue, etc. In the survival group, the platelet count was (167-315)×10^9/L,while it was (78-152)×10^9/L in the death group. The average white blood cell count was (7.78-11.52)×10^9/L and (9.91-15.93)×10^9/L in the survival and death groups respectively. The average value of lymphocyte count was (0.69-1.59)×10^9/L and (0.58-0.86)×10^9/L in the survival and death groups respectively. In the death group the glutamic-pyruvic transaminase (ALT) value was (14.0-352.0) U/L, the total bilirubin value was (6.9-34.5)μmol/L, the creatine kinase MB (CK-MB) was (16.0-162.0) U/L, the serum calcium value was (1.4-2.0) mmol/L, the C-reactive protein value was (33.1-414.0) mg/L, and the calcium reduction prime value was (0.6-100.0)μg/L. In the survival group,the ALT value was (25.0-181.0) U/L, the total bilirubin value was (4.8-25.9)μmol/L, the CK-MB value was (15.0-40.0) U/L, the serum calcium value was (1.9-2.4) mmol/L, the C-reaction protein value was (12.8-52.5) mg/L, and the procalcitonin value was (0.3-23.3)μg/L. Sixteen cases suffered severe pneumonia. Twelve patients received extracorporeal membrane oxygenation (ECMO), and 4 survived. The cause of death was mainly related to factors such as age, chronic underlying diseases and severity of illness. Conclusions Human infection with H7N9 avian influenza virus was highly pathogenic, and prone to progress into severe pneumonia, with a high mortality. Decreased platelet count was associated with mortality (t=4.07, P=0.001), predictive of patient outcome.