摘要目的 研究2009年深圳市收治的甲型H1N1流感确诊病例排毒规律和抗病毒治疗疗效.方法 75例患者均经两次鼻咽拭子甲型H1N1流感病毒核酸检测阳性(RT-PCR),此后每天检测病毒核酸直至连续两天均阴性.第1次病毒检测阳性后立即随机分三组抗病毒治疗,分别为奥司他韦(Oseltamivir)(组Ⅰ)、中药(组Ⅱ)和奥司他韦联合中药(组Ⅲ)抗病毒治疗,5 d为一疗程.应用流式细胞仪检测T细胞亚群和IL-17表达.结果 75例患者中,78.7%(59/75)在起病后甲型H1N1流感病毒核酸阳性持续≤7 d,平均年龄为(22.25±10.38)岁;21.3%(16/75)病毒持续＞7 d,年龄为(17.16±13.66)岁.对其中56例患者细胞与体液免疫功能进行分析,发现其IL-17表达明显低于季节性流感和健康人(P＜0.01).进一步研究发现,10例病毒持续＞7 d的患者IL-17表达值(1.91±0.80)明显低于46例病毒持续≤7 d者IL-17表达(3.05±1.59)(P＜0.05),也明显低于季节性流感(P＜0.01)和正常对照组(P＜0.001).比较三治疗组抗病毒治疗5 d疗程结束时病毒核酸转阴率,分别为组Ⅲ92.86%,组Ⅰ71.43%,组Ⅱ46.15%,组Ⅱ明显低于前两组(分别为P＜0.01,P＜0.05).组Ⅲ经治疗后体温恢复正常时间较组Ⅰ、组Ⅱ缩短(P＜0.05).结论 IL-17和年龄与甲型H1N1流感病毒感染及排毒时间长短可能存在一定关系.奥司他韦联合中药治疗在抗病毒疗效和减轻症状方面均有其独特优势.

abstractsObjective To investigate the A (H1N1 ) influenza patients whose viral expulsion law and antiviral effecacy in Shenzhen city in 2009. Methods A (H1N1) flu virus nucleic acid positive by reverse transcription-polymerasechain reaction (RT-PCR) with nose swabs pharynx swabs two times were showed in 75 patients. Thereafter, to detect the virus nucleic acid once per day until negative for two days in a row. Begin the antiviral therapy with Oseltamivir (Ⅰ) or the Chinese medicine (Ⅱ) or Oseltamivir combined the Chinese medicine (Ⅲ) respectively for 5 days immediately after testing virus positive at the first time. T lymphocyte subpopulation and IL-17 were identified by flow cytometry. Results 78.7% ( 59/75) of patients whose mean age was (22.25±10.38) years old virus nucleic acid turned negative in 7 days of duration. 21.3% (16/75) of patients whose mean age was (17.16±13.66) years old virus were still positive after 7 days of duration. Analysis of humoral and cellular immune function in 56 patients with A (H1N1) flushowed down IL-17 expression compared with seasonal flu and health control(P ＜ 0.01 ). 10cases virus persistence more than 7 days showed down IL-17 expression( 1.91 ± 0. 80)compared with that of 46 cases virus persistence smaller or equal to 7 days ( 3.05±1.59 ) ( P ＜ 0.05 ). Likewise, the former showed significant low IL-17 expression compared with seasonal flu ( P＜ 0.01 ) and health control ( P ＜0.001 ). Virus-negative ratio was different among three antiviral groups after a standard treatment course of 5days. The ratio was 92.86% for group Ⅲ, 71.43% for group Ⅰ and 46.15% for group Ⅱ in turn. Virusnegative ratio of the former two group was significantly higher than that of group Ⅱ ( P＜0.01, P ＜0.05 respectively). It took smaller hours of getting normathermia after treatment in group Ⅲ than that of the other two groups( P ＜ 0.05 ). Conclusion IL-17 and age are possibly interrelate with A (H1N1)flu virus infection and virus persistence. Oseltamivir combined traditional Chinese medicine treatment shows its unique advantage in antiviral efficacy and to alleviate the symptoms.