麻杏石甘汤辅助治疗流感病毒性支气管炎67例疗效观察

流感病毒性支气管炎是呼吸科常见疾病,极易合并各种细菌感染,导致较复杂的双重或多重支气管-肺部感染,甚者引起哮喘、重症肺炎等.2005年8月～2009年8月,我们采用麻杏石甘汤辅助治疗流感病毒性支气管炎患者67例,效果较满意.现报告如下.     

H1N1病毒性重症肺炎并发肺栓塞1例诊治启示

<正>重症肺炎是指伴有休克的肺炎急危重症,多见于严重感染及毒力极强的病原微生物感染,往往需要给予呼吸机通气治疗及血管活性药物的使用来维持生命,此病进展迅速,死亡率极高,预后差,临床诊治极为困难,病毒性肺炎是临床重症肺炎常见原因之一,也是临床诊疗棘手的疾病之一,特别是流感病毒所致的重症肺炎,2017年底至2018年初,全国范围内均出现H1N1流感病毒的感染,部分患者因并发重症肺炎及多脏器功能衰竭而死亡,H1N1起病     

中医药对流感病毒感染所致炎性损伤的干预机制研究概况

流感病毒感染导致的急性免疫炎性损伤是流感全身症状、重症肺炎乃至死亡的主要原因,而在流感相关免疫调控网络中炙性细胞因子的过度释放是炎性损伤的基础.中医药在历来的时行感冒的防治中积累了丰富的经验.中医药通过影响流感病毒感染机体免疫调控网络中的炎性细胞因子的分泌,抑制异常增高的促炎细胞因子的释放,并升高抗炎细胞因子及抗病毒因子的释放,纠正失衡的细胞因子的分泌,调节流感病毒感染机体的免疫应答,从而抑制流感病毒感染所致炎性损伤,并促进损伤的修复.     

产妇季节性甲型流感合并急性呼吸窘迫综合征1例

流感病毒感染性疾病是最常见的呼吸道疾病,2009年在全球范围爆发流行的新型甲型H1N1流感中,孕产妇成为高危人群,易合并重症肺炎并发ARDS,死亡率较高[1]。我们在同期成功救治了1例产妇季节性甲型流感合并重症肺炎、ARDS病人,报道如下。     

脂质体前列腺素E_1对重症肺炎大鼠CD_4~+CD_(25)~+调节性T细胞表达的影响

重症肺炎是由多种细胞因子、炎性介质介导的肺实质炎症.本研究通过观察脂质体前列腺素E_1(PGE_1)对重症肺炎CD_4~+CD_(25)~+去调节性T细胞的影响,探讨脂质体PGE_1治疗重症肺炎的机制,为临床治疗重症肺炎提供参考.     

流感病毒动物感染模型及其应用

流感病毒动物感染模型是研究流感病毒致病性、传播性和宿主抗病毒免疫机制的基础。目前已有多种动物用于流感病毒研究,主要包括小鼠、雪貂和猕猴等。本文介绍了目前已经建立的流感病毒动物感染模型及其应用,为流感病毒的防控工作提供借鉴。     

麻疹患儿合并重症肺炎的危险因素分析

目的研究麻疹患儿合并重症肺炎的危险因素,分析不同指标预测重症肺炎的价值。方法回顾性分析本院2016年12月-2018年6月收治70例麻疹患儿的临床资料,分成重症肺炎组13例,非重症肺炎组57例,采用单因素及多因素Logistic回归分析合并重症肺炎的危险因素,并将血清CRP、白蛋白及CRP/白蛋白比值对重症肺炎患儿进行受试者工作曲线(Receiver operating characteristic curves,ROC)分析。结果重症肺炎组患儿病后出疹时间,住院时间,合并喉炎,脓毒症,急性呼吸窘迫综合征比例,血CRP水平较非重症肺炎组增高,血淋巴细胞比例及白蛋白水平低于非重症肺炎组。多因素Logistic回归分析提示合并脓毒症,血清CRP增高,白蛋白降低是麻疹患儿并发重症肺炎的独立危险因素。ROC曲线分析提示CRP、白蛋白及CRP/白蛋白的曲线下面积(area under the curve,AUC)分别为0.749、0.823和0.797,CRP取24.5 mg/L为截点,灵敏度和特异度为62.9%、70.6%;白蛋白取33.5 g/L为截点,灵敏度和特异度为73.3%、80.0%;CRP/白蛋白取0.385为截点,灵敏度和特异度为79.2%、74.0%。病原学检查:病毒共计检出12株,其中呼吸道合胞病毒5株,副流感病毒5株,腺病毒2株。病原菌共计检出31株,其中革兰阳性菌9株,革兰阴性菌22株。结论合并脓毒症、血CRP增高,白蛋白降低的麻疹患儿合并重症肺炎风险增加。CRP、白蛋白和CRP/白蛋白比值对合并重症肺炎患儿的评估预测有一定价值。     

中草药抗流感病毒研究新进展

甲型流感病毒在世界范围内广泛流行,对人类造成巨大威胁,导致严重的经济损失和人员死亡.由于流感病毒高抗原变异性和有效抗病毒药物的缺乏,使得寻找有效的抗病毒措施迫在眉睫.中草药在中国有数千年历史,其在抗病毒方面有显著的作用.本文主要通过阅读国内外文献,阐述近年来中草药抗病毒机制的新进展,包括中草药主要活性成分以及其可能的抗病毒机制.     

神经氨酸酶抑制剂的研究进展

流感病毒感染所致的急性呼吸道疾病(流感)是一种严重危害人类健康的传染病,在全世界范围流行,患病率和病死率均居高不下.由于流感病毒抗原变异性和特异性的疫苗研制的滞后性,常规的疫苗不能有效地预防流感暴发与流行.因此,抗病毒药物就成为了抗病毒的第一道防线.目前被批准上市的抗病毒药物有M2离子通道阻滞剂和神经氨酸酶抑制剂(neuraminidase inhibitors,NAIs)两大类.M2离子通道阻滞剂不良反应大,且只能防治甲型流感病毒,对乙型流感病毒无效;NAIs可以抑制高致病性的甲型和乙型流感病毒,已成为目前抗病毒药物研究的热点.目前已经上市的NAIs有奥司他韦、扎那米韦和帕拉米韦.本文介绍了NAIs的作用机制、药效学、药动学并着重对NAIs的临床研究进展进行综述.     

潮汕地区呼吸道感染患儿腺病毒流行情况及临床分析

目的 了解潮汕地区呼吸道感染患儿腺病毒流行情况及临床特征.方法 收集2012年7月至2016年6月因呼吸道感染入住汕头大学医学院第二附属医院儿科患儿的咽拭子标本2 668份,应用多重聚合酶链反应(PCR)技术,对咽拭子标本行腺病毒、呼吸道合胞病毒、人鼻病毒、WU多瘤病毒、人博卡病毒、流感病毒A、B型、副流感病毒1、3型、人类偏肺病毒共10种(型)病毒检测,并对腺病毒阳性病例进行临床资料分析.结果 2 668份咽拭子标本中,病毒阳性1 388份(52.02%),其中腺病毒95例(3.53%);腺病毒感染呈全年散发,年龄主要集中发生在6岁以下,尤其是3岁以下;主要临床症状表现为发热、咳嗽、喘息、气促,其中混合感染组中,随着合并感染病毒数增加,咳嗽、喘息症状越明显,95例中仅4例(4.21%)患儿符合重症肺炎诊断.结论 腺病毒2012年7月至2016年6月腺病毒在潮汕地区没有发生规模以上的流行和暴发;腺病毒与其他病毒混合感染普遍存在;呼吸道腺病毒感染的临床表现和实验室检查及影像学检查均无特异性特征,但随着合并感染病毒种类数目的增加,咳嗽、喘息、气促发生率更高;近4年来潮汕地区腺病毒呼吸道感染临床症状普遍较轻,重症肺炎发生率低.     

Engineered viral vaccine constructs with dual specificity: avian influenza and Newcastle disease

Avian influenza viruses of the H5 and H7 hemagglutinin subtypes, and Newcastle disease virus (NDV), are important pathogens in poultry worldwide. Specifically, the highly pathogenic H5N1 avian influenza virus is a particular threat because it has now occurred in more than 40 countries on several continents. Inasmuch as most chickens worldwide are vaccinated with a live NDV vaccine, we embarked on the development of vaccine prototypes that would have dual specificity and would allow a single immunization against both avian influenza and Newcastle disease. Using reverse genetics, we constructed a chimeric avian influenza virus that expressed the ectodomain of the hemagglutinin-neuraminidase gene of NDV instead of the neuraminidase protein of the H5N1 avian influenza virus. Our second approach to creating a bivalent vaccine was based on expressing the ectodomain of an H7 avian influenza virus hemagglutinin in a fusogenic and attenuated NDV background. The insertion into the NDV genome of the foreign gene (containing only its ectodomain, with the transmembrane and cytoplasmic domains derived from the F protein of NDV) resulted in a chimeric virus with enhanced incorporation of the foreign protein into virus particles. A single immunization of chickens with this improved vaccine prototype virus induced not only a 90% protection against an H7N7 highly pathogenic avian influenza virus, but also complete immunity against a highly virulent NDV. We propose that chimeric constructs should be developed for convenient, affordable, and effective vaccination against avian influenza and Newcastle disease in chickens and other poultry.     

H6N1亚型禽流感病毒跨种属传播研究进展

禽流感病毒H6N1亚型广泛存在于水禽和陆禽,是最常分离到的甲型流感病毒亚型,遗传分析表明该病毒可能是高致病禽流感病毒H5N1的前体。随着病毒基因的持续进化,H6N1可跨种间屏障传播至哺乳动物,其对于哺乳动物小鼠、猪和雪貂已经具有较强感染能力。血清流行病学调查结果显示少数人H6禽流感病毒抗体阳性,2013年5月,我国台湾出现全球首例人类感染H6N1亚型流感病毒。因此,H6N1病毒宿主范围不断扩大,在这些宿主内可发生病毒基因突变、基因重配,进而演变为具有感染人类潜能的新变异株的可能。本文从病原学、流行病学、病毒感染哺乳动物和人类等方面对H6N1亚型禽流感病毒的研究进展进行综述,以期为H6N1禽流感病毒的防控提供参考。     

Genomic and Phylogenetic Characterization of Novel,Recombinant H5N2 Avian Influenza Virus Strains Isolated from Vaccinated Chickens with Clinical Symptoms in China

Infection of poultry with diverse lineages of H5N2 avian influenza viruses has been documented for over three decades in different parts of the world, with limited outbreaks caused by this highly pathogenic avian influenza virus. In the present study, three avian H5N2 influenza viruses, A/chicken/Shijiazhuang/1209/2013, A/chicken/Chiping/0321/2014, and A/chicken/Laiwu/0313/2014, were isolated from chickens with clinical symptoms of avian influenza. Complete genomic and phylogenetic analyses demonstrated that all three isolates are novel recombinant viruses with hemagglutinin (HA) and matrix (M) genes derived from H5N1, and remaining genes derived from H9N2-like viruses. The HA cleavage motif in all three strains (PQIEGRRRKR/GL) is characteristic of a highly pathogenic avian influenza virus strain. These results indicate the occurrence of H5N2 recombination and highlight the importance of continued surveillance of the H5N2 subtype virus and reformulation of vaccine strains.     

H7N9禽流感及相关疫情分析评估

2016年10月起至今发生的第5波人感染H7N9禽流感疫情比前4波严重,截止至2017年3月8日,本波疫情感染者数量已达历年累积报告数的40.00%。病原学研究发现最近广东分离的两株H7N9病毒在HA的链接肽位置发生插入性变异导致对禽致病性有所增强,但绝大多数分离株与前4波疫情中H7N9病毒病原学特征无明显区别;流行病学调查研究显示,除有3起可能人传人事件外,与前4波比较,患者之间也没有明显的流行病学关联。因此,基于疫情分析及风险评估认为H7N9禽流感仍会扩散传播并继续发生新发病例,但流行病学和病原学分析认为该病毒在人际间持续传播的可能性低。本综述认为加强H7N9禽流感病原学与流行病学的研究具有重要的公共卫生意义。     

A novel mechanism for the acquisition of virulence by a human influenza A virus

Cleavage of the hemagglutinin (HA) molecule by proteases is a prerequisite for the infectivity of influenza A viruses. Here, we describe a novel mechanism of HA cleavage for a descendant of the 1918 pandemic strain of human influenza virus. We demonstrate that neuraminidase, the second major protein on the virion surface, binds and sequesters plasminogen, leading to higher local concentrations of this ubiquitous protease precursor and thus to increased cleavage of the HA. The structural basis of this unusual function of the neuraminidase molecule appears to be the presence of a carboxyl-terminal lysine and the absence of an oligosaccharide side chain at position 146 (N2 numbering). These findings suggest a means by which influenza A viruses, and perhaps other viruses as well, could become highly pathogenic in humans.     

Avian influenza in shorebirds: experimental infection of ruddy turnstones (Arenaria interpres) with avian influenza virus

Please cite this paper as: Hall et al. (2012) Avian influenza in shorebirds: experimental infection of ruddy turnstones (Arenaria interpres) with avian influenza virus. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00358.x. Background Low pathogenic avian influenza viruses (LPAIV) have been reported in shorebirds, especially at Delaware Bay, USA, during spring migration. However, data on patterns of virus excretion, minimal infectious doses, and clinical outcome are lacking. The ruddy turnstone (Arenaria interpres) is the shorebird species with the highest prevalence of influenza virus at Delaware Bay. Objectives The primary objective of this study was to experimentally assess the patterns of influenza virus excretion, minimal infectious doses, and clinical outcome in ruddy turnstones. Methods We experimentally challenged ruddy turnstones using a common LPAIV shorebird isolate, an LPAIV waterfowl isolate, or a highly pathogenic H5N1 avian influenza virus. Cloacal and oral swabs and sera were analyzed from each bird. Results Most ruddy turnstones had pre‐existing antibodies to avian influenza virus, and many were infected at the time of capture. The infectious doses for each challenge virus were similar (10^3·6–10^4·16 EID₅₀), regardless of exposure history. All infected birds excreted similar amounts of virus and showed no clinical signs of disease or mortality. Influenza A‐specific antibodies remained detectable for at least 2 months after inoculation. Conclusions These results provide a reference for interpretation of surveillance data, modeling, and predicting the risks of avian influenza transmission and movement in these important hosts.     

Detection of influenza viral gene in European starlings and experimental infection

Please cite this paper as: Qin et al. (2011) Detection of influenza viral gene in European starlings and experimental infection. Influenza and Other Respiratory Viruses 5(4), 268–275 Background European starlings (Sturnus vulgaris) are common, widely distributed birds in North America that frequently come into contact with agricultural operations. However, starlings have been one of the neglected land‐based wild bird species for influenza surveillance. Objectives To study the potential role of starlings in the ecology and epidemiology of influenza virus. Methods We collected 328 digestive and 156 tracheal samples from starlings in Ohio in years 2007 (July) to 2008 (August) and screened for the presence of influenza virus by real‐time RT‐PCR, standard RT‐PCR and virus isolation using embryonated chicken eggs. In addition, we conducted an experimental infection study to evaluate the replication and induction of antibody response by two low pathogenic avian influenza (AI) viruses in starlings. Results Although virus isolation was negative, we confirmed 21 influenza positive digestive and tracheal samples by real‐time and standard RT‐PCR tests. Phylogenetic analysis revealed that five NS genes recovered from Starlings belonged to NS subtype A and were most similar to the NS genes from a wild aquatic bird origin isolate from Ohio. Experimental infection studies using two low pathogenic AI strains showed that starlings could be infected, shed virus, and seroconvert. Conclusions This study shows that starlings can carry influenza virus that is genetically similar to wild aquatic bird origin strains and may serve as a carrier of influenza virus to domestic animals.     

The evolution of H5N1 influenza viruses in ducks in southern China

The pathogenicity of avian H5N1 influenza viruses to mammals has been evolving since the mid-1980s. Here, we demonstrate that H5N1 influenza viruses, isolated from apparently healthy domestic ducks in mainland China from 1999 through 2002, were becoming progressively more pathogenic for mammals, and we present a hypothesis explaining the mechanism of this evolutionary direction. Twenty-one viruses isolated from apparently healthy ducks in southern China from 1999 through 2002 were confirmed to be H5N1 subtype influenza A viruses. These isolates are antigenically similar to A/Goose/Guangdong/1/96 (H5N1) virus, which was the source of the 1997 Hong Kong "bird flu" hemagglutinin gene, and all are highly pathogenic in chickens. The viruses form four pathotypes on the basis of their replication and lethality in mice. There is a clear temporal pattern in the progressively increasing pathogenicity of these isolates in the mammalian model. Five of six H5N1 isolates tested replicated in inoculated ducks and were shed from trachea or cloaca, but none caused disease signs or death. Phylogenetic analysis of the full genome indicated that most of the viruses are reassortants containing the A/Goose/Guangdong/1/96-like hemagglutinin gene and the other genes from unknown Eurasian avian influenza viruses. This study is a characterization of the H5N1 avian influenza viruses recently circulating in ducks in mainland China. Our findings suggest that immediate action is needed to prevent the transmission of highly pathogenic avian influenza viruses from the apparently healthy ducks into chickens or mammalian hosts.