NEJM：H7N9更喜欢慢性病和肿瘤患者

　　据《劳动报》报道，由复旦大学、浙江大学、北京朝阳医院、协和医院等全国临床科学家共同参与、首次全面总结的研究结果显示，人感染H7N9禽流感病人中，多数患者伴有基础疾病，这是这些病人出现急性呼吸窘迫综合征的独立危险因素。近日，全球医学顶尖杂志《新英格兰医学杂志》以《111例人感染H7N9禽流感病例的临床发现》为题已在线发表了这一最新研究成果。

　　据悉，基础疾病主要指三大类疾病，一是有基础代谢障碍，如内分泌失调、糖尿病；二是免疫功能低下，如先天性或获得性免疫缺陷病；三是有重大的慢性消耗性疾病，如肿瘤。论文首次全面分析了截至5月10日上海、浙江、安徽、江苏等省市收治的111例人感染H7N9禽流感病例的临床资料,结果发现：在111例患者中,年龄中位数为61岁，42.3％的患者年龄在65岁以上；女性患者占31.5％；76.6％的患者需要在重症监护病房接受治疗，27%的患者死亡；入院时97.3％的患者出现肺炎表现。患者以老年男性为主，61.3％的患者至少伴随有一种基础疾病,即多数患者伴有基础疾病。研究表明，患者死亡与接受抗病毒治疗时间较晚、以及基础疾病与出现急性呼吸窘迫综合征有关。

Clinical Findings in 111 Cases of Influenza A (H7N9) Virus Infection
Background
During 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.
Methods
Using medical charts, we collected data on 111 patients with laboratory-confirmed avian-origin influenza A (H7N9) infection through May 10, 2013.
Results
Of 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 thrombocytopenia 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).
Conclusions
During 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.)