人感染H7N9禽流感病毒性肺炎临床影像学诊断及疗效评价

新发传染病电子杂志 ›› 2017, Vol. 2 ›› Issue (1): 46-49.

人感染H7N9禽流感病毒性肺炎临床影像学诊断及疗效评价

邓莹莹¹, 黄华², 袁静², 李宏军³, 陆普选²

1.深圳市盐田区人民医院放射科,广东深圳 518081;
2.深圳市第三人民医院放射科,广东深圳 518020;
3.首都医科大学附属北京佑安医院放射科,北京 100069

收稿日期:2017-02-01 出版日期:2017-02-28 发布日期:2020-07-01
通讯作者: 陆普选,Email：lupuxuan@126.com
基金资助:
北京市医院管理局临床医学发展专项经费资助(扬帆计划)(ZYLX201511); 深圳市知识创新计划重点项目（JCY20130401164750006; JCY20150207181301）

Imaging findings and therapeutic evaluation of pneumonia caused by human infected H7N9 avian influenza virus

DENG Ying-ying¹, HUANG Hua², YUAN Jing², LI Hong-jun³, LU Pu-xuan²

1. Department of Radiology,ShenZhen Yantian People's Hospital,Guangdong Shenzhen 518081,China;
2. Department of Radiology,ShenZhen Third People’s Hospital,Guangdogn Shenzhen 518020,China;
3. Department of Radiology,Beijing Affiliated Hospital of Capital Medical University,Beijing 100069,China

Received:2017-02-01 Online:2017-02-28 Published:2020-07-01

摘要/Abstract

摘要： 目的探讨人感染H7N9禽流感病毒性肺炎的临床影像学表现及病变疗效影像学评价。方法收集37例人感染H7N9禽流感病毒性肺炎患者的临床病史及胸部影像学资料,回顾性分析患者发病时以及治疗后流行病学、临床特点以及胸部影像学表现特点。结果 37例人感染H7N9禽流感病毒性肺炎患者中5例存在明确活禽接触史;37例患者胸部影像学检查肺叶内可见大片状实变影,37例患者肺叶内可见磨玻璃样影,37例患者均见胸膜反应,其中25例患者可见单侧或双侧胸膜腔积液;患者治疗后复查可见肺叶内残留条索影33例（4例患者死亡）,小叶间隔增厚33例,胸膜下弧线影16例,间隔旁肺气肿13例,肋膈角周围胸膜增厚8例。结论人感染H7N9禽流感病毒性肺炎患者最常见的胸部影像学表现是肺叶内实变影和磨玻璃样影,病灶变化迅速;随访观察肺叶内可见残留条索影,小叶间隔增厚,呈现早期纤维化的一些特点,影像学在疾病的诊断和治疗过程中发挥重要的作用。

关键词: 禽流感, 甲型H7N9病毒, 肺炎, 放射摄影术, X线计算机成像

Abstract: Objective The purpose of this study was to characterize the clinical and radiological findings of H7N9 avian influenza virus infection. Methods A retrospective review of 37 patients suffering from H7N9 avian influenza virus infection was performed.Thoracic X-ray and CT results of the patients and clinical data were available. Results 5 patients had absolutely contact with avian. Consolidation lesions and GGOs were found in the lungs of all 37 patients,and all consolidation and GGOs absorbed quickly after antiviral therapy. After treatment,streaks and interlobular septa thickening were both found in 33 patients.Pleural arcs were found in 16 patients. Conclusion The most common imaging findings were consolidation and GGOs in the lungs of patients with H7N9 avian influenza virus infection. After treatment of antiviral therapy,most of the lesions absorbed quickly,and a small number of the lesions such as streaks left in the lung,suggesting early lung fibrosis.

Key words: Influenza in birds, H7N9 virus, Pneumonia, Radiography, X-ray computed tomography

邓莹莹, 黄华, 袁静, 李宏军, 陆普选. 人感染H7N9禽流感病毒性肺炎临床影像学诊断及疗效评价[J]. 新发传染病电子杂志, 2017, 2(1): 46-49.

DENG Ying-ying, HUANG Hua, YUAN Jing, LI Hong-jun, LU Pu-xuan. Imaging findings and therapeutic evaluation of pneumonia caused by human infected H7N9 avian influenza virus[J]. Electronic Journal of Emerging Infectious Diseases, 2017, 2(1): 46-49.

参考文献

[1] Gao R,Cao B,Hu Y,et al.Humam infection with a novel avian-origin influenza A(H7N9) virus[J].N Engl J Med,2013,368(20):1888-1897.
[2] 孔东锋,谢旭,梅树江,等.深圳市2013年和2014年首例人感染H7N9禽流感病例的流行病学调查情况[J].医学动物防制,2015,31(2):213-215.
[3] Zeng Zheng,Huang Xiang-rong,Lu Pu-xuan,et al.Imaging and pathological analysis of severe pneumonia caused by human infections with avian influenza A(H7N9)[J].Radiology of Infectious Diseases,2015,1(12):64-69.
[4] 国家卫生计生委.人感染H7N9禽流感诊疗方案(2014年版)[EB/OL].[2014-01-26].http://www.nhfpc.gov.cn/yzygj/s3593g/201401/3f69fe196ecb4cfc8a2d6d96182f8b22.shtml.
[5] 李宏军,陆普选,施裕新.流行性感冒影像学[M].北京:科学出版社,2016:1-93.
[6] 陆普选,周伯平.新发传染病临床影像诊断[M].北京:人民卫生出版社,2013:7-87
[7] Pu-xuan Lu,Bo-ping Zhou.Diagnostic Imaging of Emerging Infectious Diseases[M].Netherlands:Springer,2016:29-56.
[8] 闫铁成,肖丹,王波,等.中国大陆130例人感染H7N9禽流感病例流行病学特征分析[J].中华疾病控制杂志,2013,17(8):651-654.
[9] Wang XF,Shi GC,Wan HY,et al.Clinical features of three avian infuenza H7N9 virus-infected patients in Shanghai[J].Clin Respir J,2014, 8(4):410-416.
[10] 蔡瑞萍,杜瑞宾,李添.人感染H7N9禽流感肺部影像学表现及动态变化[J].创伤与急诊电子杂志,2014,2(3):19-22.
[11] 何苏苏,骆定海,林云,等.人感染H7N9禽流感病毒报道及文献复习[J].中华医院感染学杂志,2016,26(16):3783-3785.
[12] Wang Q,Zhang Z,Shi Y,et al.Emerging H7N9 influenza A(novel reassortant avian-origin) pneumonia:radiologic findings[J].Radiology,2013,268(3):882-889.
[13] 许少华,李宏军,李宁,等.人感染H7N9禽流感与甲型H1N1流感重症肺炎的临床及CT影像比较[J].放射学实践,2014,29(7):756-759.
[14] 辛小燕,常莹,孙晓敏,等.甲型H7N9病毒性肺炎的胸部影像学表现[J].医学影像学杂志,2015,25(4):637-640.
[15] 舒红梅,施炜,方长太.人感染H7N9禽流感3例诊疗分析[J].蚌埠医学院学报,2015,40(11):1538-1541.
[16] 黄湘荣,曾政,陆普选,等.12例人感染H7N9禽流感病毒性肺炎的临床影像学分析[J].中国CT和MRI杂志,2014,12(2):8-11.
[17] Dai J,Zhou X,Dong D,et al.Human infection with a novel avian-origin influenza A(H7N9) virus:serial chest radiographic and CT findings[J].Chin Med J(Engl),2014,127(12):2206-2211.
[18] 孙洪跃,王仁贵,宋鲁新,等.SARS的X线表现[J].中国医学影像技术,2003,19(7):793-795.
[19] 刘波,谭四平,欧爱华,等.SARS与普通肺炎的X线鉴别诊断[J].中国医学影像技术,2003,19(7):796-798.
[20] 李晶晶,曾政,陆普选,等.人感染H7N9禽流感病毒性肺炎影像学随访研究[J].放射学实践,2016,31(3):228-231.
[21] 陆普选,曾政,郑斐群,等.人感染H7N9禽流感病毒性重症肺炎的影像学表现及动态变化特点[J].放射学实践,2014,29(7):740-744.
[22] Xia JB,Zhu J,Hu J,et al.H7N9 influenza A-induced pneumonia associated with acute myelitis in an adult[J]. Intern Med,2014,53(10):1093-1095.
[23] Xia JB,Zhu J,Hu J,et al.H7N9 influenza A-induced pneumonia associated with acute myelitis in an adult[J]. Intern Med,2014,53(10):1093-1095.