Clinical and Immunological Characteristics of Human Infections With H5N6 Avian Influenza Virus
Clinical and Immunological Characteristics of Human Infections With H5N6 Avian Influenza Virus
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人感染H5N6禽流感病毒的临床和免疫学特征
DOI：
10.1093/cid/ciy681
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发表时间：
2019-04-01
影响因子：
11.8
通讯作者：
Liu, Yingxia
中科院分区：
文献类型：
--
作者：
Bi, Yuhai;Tan, Shuguang;Liu, Yingxia
背景
自2013年以来，H5 N6禽流感病毒（AIV）在中国和东南亚引起了零星的反复爆发，有19人感染，13人死亡。其中17例感染发生在2015年12月以来，表明H5 N6病例的频率最近有所上升。
方法
为了评估H5 N6病毒对人类的相对威胁，我们总结并比较了感染H5 N6（n = 19）患者的临床数据与两种主要公共卫生问题亚型H5 N1（n = 53）和H7N9（n = 160）的数据。为了评估指示预后的免疫应答，我们比较了感染H5 N6、H5 N1、H7N9和2009年大流行性H1N1的患者的血清细胞因子/趋化因子浓度，并表征了1名存活和2名非存活H5 N6患者的特异性免疫应答。
结果
发现H5 N6患者与H5 N1和H7N9患者相比，淋巴细胞减少症和丙氨酸氨基转移酶和乳酸脱氢酶水平升高的发生率更高。与感染其他AIV亚型的患者相比，H5 N6患者中检测到高细胞因子血症的频率明显更高。获得性免疫的评估表明，体液和细胞反应可以检测到在H5 N6感染的幸存者，但细胞反应在非幸存者缺席。此外，与非存活者相比，存活患者的促炎和抗炎细胞因子/趋化因子浓度较低。
结论
我们的研究结果支持H5 N6病毒可能是一个主要的公共卫生威胁，并表明这是可能的，早期获得细胞免疫和较低浓度的细胞因子/趋化因子有助于我们的患者的生存。需要分析更多的患者样本才能得出具体结论。
BACKGROUND
H5N6 avian influenza virus (AIV) has caused sporadic, recurring outbreaks in China and Southeast Asia since 2013, with 19 human infections and 13 deaths. Seventeen of these infections occurred since December 2015, indicating a recent rise in the frequency of H5N6 cases.
METHODS
To assess the relative threat of H5N6 virus to humans, we summarized and compared clinical data from patients infected with H5N6 (n = 19) against data from 2 subtypes of major public health concern, H5N1 (n = 53) and H7N9 (n = 160). To assess immune responses indicative of prognosis, we compared concentrations of serum cytokines/chemokines in patients infected with H5N6, H5N1, H7N9, and 2009 pandemic H1N1 and characterized specific immune responses from 1 surviving and 2 nonsurviving H5N6 patients.
RESULTS
H5N6 patients were found to have higher incidences of lymphopenia and elevated alanine aminotransferase and lactate dehydrogenase levels compared with H5N1 and H7N9 patients. Hypercytokinemia was detected at substantially higher frequencies from H5N6 patients compared to those infected with other AIV subtypes. Evaluation of adaptive immunity showed that both humoral and cellular responses could be detected in the H5N6-infected survivor, but cellular responses were absent in the nonsurvivors. In addition, the surviving patient had lower concentrations of both pro- and anti-inflammatory cytokines/chemokines compared to the nonsurvivors.
CONCLUSIONS
Our results support that H5N6 virus could potentially be a major public health threat, and suggest it is possible that the earlier acquisition of cellular immunity and lower concentrations of cytokines/chemokines contributed to survival in our patient. Analysis of more patient samples will be needed to draw concrete conclusions.