Clinical Findings in 111 Cases of Influenza A (H7N9) Virus Infection
Clinical Findings in 111 Cases of Influenza A (H7N9) Virus Infection
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111例甲型H7N9流感病毒感染临床观察
DOI：
10.1056/nejmoa1305584
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发表时间：
2013-06-13
影响因子：
158.5
通讯作者：
Li, Lan-Juan
中科院分区：
文献类型：
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作者：
Gao, Hai-Nv;Lu, Hong-Zhou;Li, Lan-Juan
2013年春季，一种新型禽源性甲型H7N9流感病毒在中国出现并在人间传播。数据缺乏的临床特征，由这种病毒引起的感染。方法使用医疗图表，我们收集了111例实验室确诊的禽流感A（H7N9）感染的数据，通过2013年5月10日。在我们研究的111例患者中，76.6%被送入重症监护室（ICU），27.0%死亡。中位年龄为61岁，42.3%为65岁或以上; 31.5%为女性。共有61.3%的患者至少有一种基础疾病。发热和咳嗽是最常见的临床症状。入院时，108例患者（97.3%）的结果与肺炎一致。双侧磨玻璃影和实变是典型的影像学表现。88.3%的患者出现淋巴细胞减少，73.0%的患者出现血小板减少。108例患者（97.3%）在发病后中位数7天开始抗病毒药物治疗。从发病和从开始抗病毒治疗到实时逆转录酶聚合酶链反应检测阴性病毒检测结果的中位时间分别为11天（四分位距，9至16）和6天（四分位距，4至7）。多因素分析显示，合并疾病是急性呼吸窘迫综合征（ARDS）的唯一独立危险因素（比值比，3.42; 95%置信区间，1.21至9.70; P = 0.02）。结论在评估期间，新型H7N9病毒引起严重疾病，包括肺炎和ARDS，重症监护室入院率和死亡率都很高（国家自然科学基金等资助）
BACKGROUNDDuring the spring of 2013, a novel avian-origin influenza A (H7N9) virus emerged and spread among humans in China. Data were lacking on the clinical characteristics of the infections caused by this virus.METHODSUsing medical charts, we collected data on 111 patients with laboratory-confirmed avian-origin influenza A (H7N9) infection through May 10, 2013.RESULTSOf the 111 patients we studied, 76.6% were admitted to an intensive care unit (ICU), and 27.0% died. The median age was 61 years, and 42.3% were 65 years of age or older; 31.5% were female. A total of 61.3% of the patients had at least one underlying medical condition. Fever and cough were the most common presenting symptoms. On admission, 108 patients (97.3%) had findings consistent with pneumonia. Bilateral ground-glass opacities and consolidation were the typical radiologic findings. Lymphocytopenia was observed in 88.3% of patients, and thrombo-cytopenia in 73.0%. Treatment with antiviral drugs was initiated in 108 patients (97.3%) at a median of 7 days after the onset of illness. The median times from the onset of illness and from the initiation of antiviral therapy to a negative viral test result on real-time reverse-transcriptase-polymerase-chain-reaction assay were 11 days (interquartile range, 9 to 16) and 6 days (interquartile range, 4 to 7), respectively. Multivariate analysis revealed that the presence of a coexisting medical condition was the only independent risk factor for the acute respiratory distress syndrome (ARDS) (odds ratio, 3.42; 95% confidence interval, 1.21 to 9.70; P = 0.02).CONCLUSIONSDuring the evaluation period, the novel H7N9 virus caused severe illness, including pneumonia and ARDS, with high rates of ICU admission and death. (Funded by the National Natural Science Foundation of China and others.)