检验医学 ›› 2013, Vol. 28 ›› Issue (9): 745-748.DOI: 10.3969/j.issn.1673-8640.2013.09.003

• H7N9禽流感的实验室检测专题 • 上一篇    下一篇

H7N9禽流感患者外周血常规和C反应蛋白的变化及其临床意义

李昕,沈震,张蓓,卢美娟,胡香南,胡绿荫,张军   

  1. 上海市公共卫生临床中心医学检验科,上海 201508
  • 收稿日期:2013-06-21 修回日期:2013-09-25 出版日期:2013-09-15 发布日期:2013-09-25
  • 通讯作者: 张 军,联系电话:021-37990333-7295。
  • 作者简介:李 昕,女,1985年生,硕士,技师,主要从事感染性疾病实验室诊断工作。

Change and clinical significance of peripheral blood cells and C reactive protein in patients with avian influenza A(H7N9)virus infection

LI Xin,SHEN Zhen,ZHANG Bei,LU Meijuan,HU Xiangnan,HU L鼀in,ZHANG Jun.   

  1. Department of Clinical Laboratory,Shanghai Public Health Clinical Center,Shanghai 201508,China
  • Received:2013-06-21 Revised:2013-09-25 Online:2013-09-15 Published:2013-09-25

摘要: 目的 探讨H7N9禽流感患者外周血常规和C反应蛋白(CRP)的变化,为临床诊断、治疗及病情监测提供依据。方法 选取18例H7N9禽流感患者(H7N9组),以2009年的20例甲型H1N1流感患者(H1N1组)及20名健康体检者(正常对照组)作为对照。根据患者康复情况将H7N9组再分为轻症组12例、重症组6例。分析各组血常规,同时测定H7N9组外周血CRP水平。结果 与正常对照组比较,H7N9组患病初期白细胞(WBC)总数无明显变化,淋巴细胞(Lym)计数明显降低(P<0.05),同时伴有血小板(PLT)和嗜酸性粒细胞(Eos)下降(P<0.05);重症组中性粒细胞(Neu)计数明显增高(P<0.05),轻症组和重症组之间各项指标均无差异(P>0.05)。与H1N1组比较,H7N9组入院时的血象特点相似,但Lym计数下降更为明显(P<0.05)。与治疗前比较,轻症组治疗后PLT、Lym及Eos计数明显上升(P<0.05)。H7N9组入院时CRP明显升高,重症较轻症组升高更为明显(P<0.05)。轻症组治疗后CRP明显下降,与治疗前比较差异有统计学意义(P<0.05)。结论 外周血CRP水平对区分H7N9禽流感患者轻、重症及判断预后有一定的提示作用。H7N9禽流感患者外周血常规的变化与甲型H1N1流感存在相似之处,特点并不明显,应充分结合多方面信息以明确诊断和判断预后,以防出现严重的疫情后果。

关键词: H7N9禽流感病毒, 外周血象, C反应蛋白

Abstract: Objective To investigate the changes of peripheral blood cells and C reactive protein (CRP) in patients with avian influenza A(H7N9)virus infection, and provide the relative reference for clinical diagnosis,treatment and monitor. Methods A total of 18 patients with avian influenza A(H7N9)virus infection (H7N9 group) were enrolled in the study, 20 patients with avian influenza A (H1N1)virus infection in 2009 (H1N1 group) were enrolled as control group, and 20 healthy subjects were also enrolled as healthy control group. H7N9 group was sub-classified into mild group (12 cases) and severe group (6 cases). The peripheral blood cells in all groups were quantified, and the serum CRP in H7N9 group was also determined. Results For H7N9 group,the white blood cell (WBC) count did not change much in the early period of infection onset,while the lymphocytes (Lym) decreased significantly when compared with healthy control group (P<0.05),together with the decreasing of platelets (PLT) and eosinophils (Eos)(P<0.05). For the severe group,the neutrophils (Neu) increased significantly when compared with those of healthy control group (P<0.05). However,no statistical significance was observed for all the parameters between the mild and severe groups (P>0.05). The clinical characteristics of peripheral blood cells in H7N9 group were similar with those in H1N1 group in 2009,while the Lym decreased more significantly(P<0.05). The PLT, Lym and Eos all increased significantly after treatment in the mild group when compared with those of pre-treatment(P<0.05). The serum CRP increased significantly in H7N9 group after administration,which was more obvious in the severe group than in the mild group (P<0.05). Similarly,the serum CRP decreased after treatment in the mild group when compared with that of pre-treatment (P<0.05). Conclusions The serum CRP level may be a parameter on distinguishing the mild group from severe group. However,the clinical characteristics of peripheral blood cells in patients with avian influenza A (H7N9)virus infection are similar with those in patients with avian influenza A(H1N1)virus infection in 2009. Clinical information regarding different aspects should be carefully collected for clinical diagnosis, prognosis assessment and prevention of influenza outbreaks.

Key words: Avian influenza A(H7N9)virus, Peripheral blood cell, C reactive protein

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