本文選題：麻疹 + 肺炎　； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2016年博士論文

【摘要】：背景2013年底至2014年上半年,北京、沈陽(yáng)等地出現(xiàn)大量麻疹患者。此次流行的麻疹在臨床表現(xiàn)上有何特點(diǎn)?麻疹患者免疫學(xué)特點(diǎn)如何?麻疹發(fā)病率突然升高是否因?yàn)槌霈F(xiàn)病毒基因變異?為了回答上述問(wèn)題我們進(jìn)行了相關(guān)研究。材料和方法收集2014年1月-5月在解放軍302醫(yī)院住院的112例麻疹患者的臨床資料；采集30例麻疹患者急性期、恢復(fù)期及30例對(duì)照者外周血,采用流式細(xì)胞術(shù)進(jìn)行免疫學(xué)檢測(cè),并對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)分析.同期采集解放軍第302醫(yī)院112例(同上)和沈陽(yáng)市第六人民醫(yī)院150例麻疹患者的血清及咽拭子,檢測(cè)麻疹病毒IgM抗體,分離病毒進(jìn)行基因測(cè)序,分析麻疹病毒N基因和H基因的分子特征.結(jié)果1.麻疹患者的流行病學(xué)及臨床特點(diǎn)：在112例麻疹患者中,發(fā)病前有麻疹患者接觸者46例(41.07%)；78例(69.64%)患者未曾接種過(guò)麻疹疫苗；成人患者85例(75.89%)發(fā)熱后出疹時(shí)間3天(2～4),熱程天數(shù)7天(6～9)；臨床表現(xiàn)以發(fā)熱(100%)、皮疹(100%)、咳嗽(90.18%)、流涕(85.71%).結(jié)膜炎(100%)和口腔柯氏斑(78.57%)為主.麻疹并發(fā)肺炎37例(33.04%),其中8個(gè)月10例(76.92%)、18歲19例(22.35%),差異有統(tǒng)計(jì)學(xué)意義(P0.01)；肝損害56例(50%),其中8個(gè)月2例(3.57%)、18歲51例(91.07%),差異有統(tǒng)計(jì)學(xué)意義(P0.01). COX回歸模型提示,麻疹患者是否并發(fā)肺炎是影響總病程的獨(dú)立危險(xiǎn)因素(P0.01)。2.麻疹患者免疫學(xué)和病毒學(xué)特點(diǎn)：成人麻疹患者急性期和恢復(fù)期CD4+IL17+、CD4+IFNγ+及CD8+IFN γ+ T淋巴細(xì)胞比例均較對(duì)照組降低(P0.05)；急性期麻疹患者CD8+IL22+細(xì)胞比例明顯升高,與恢復(fù)期和對(duì)照組比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。麻疹患者調(diào)節(jié)性T淋巴細(xì)胞比例明顯升高。兩家醫(yī)院共262例麻疹患者中,病毒IgM抗體陽(yáng)性234例(89.32%),咽拭子分離麻疹病毒陽(yáng)性82株(31.30%),均為H1a基因型；H蛋白基因測(cè)序顯示有S240N、Y481N和P397L替代變異。結(jié)論1.在112例患者中,18歲麻疹患者肺炎發(fā)生率較高(48.65%),成人麻疹患者肝損害發(fā)生率較高(60.00%)。肺炎是影響麻疹患者總病程的獨(dú)立危險(xiǎn)因素。2. 成人麻疹患者體內(nèi)淋巴細(xì)胞總數(shù)降低,急性期麻疹患者CD4+T淋巴細(xì)胞呈下降趨勢(shì),CD8+T淋巴細(xì)胞呈上升趨勢(shì)。麻疹患者CD3+IFNγ、CD4+IL17+T淋巴細(xì)胞明顯減少；急性期CD8+IL22+ T淋巴細(xì)胞明顯升高,恢復(fù)期逐漸下降。麻疹患者Treg細(xì)胞在急性期和恢復(fù)期比例均明顯升高。3. 北京和沈陽(yáng)地區(qū)麻疹疫情的病毒以H1a基因型為主,為中國(guó)目前主要流行的麻疹基因型。此外,H蛋白基因測(cè)序結(jié)果提示,目前施行的麻疹減毒活疫苗仍能有效保護(hù)易感人群。
[Abstract]:Background : In the first half of 2013 to the first half of 2014 , there were a large number of measles patients in Beijing , Shenyang and the like . What are the characteristics of measles in the clinical manifestation ? How does the measles incidence increase suddenly ? Did the measles incidence increase suddenly ? In order to answer the above - mentioned problems , we carried out related research . Materials and methods collect the clinical data of 112 measles patients who were hospitalized in 302 hospitals of PLA from January to May 2014 .
In the same period , 112 cases ( ibid . ) and 150 measles patients in the Sixth People ' s Hospital of Shenyang City were collected , and the molecular characteristics of measles virus N gene and H gene were analyzed . Results 1 . Epidemiological and clinical characteristics of measles virus N gene and H gene were analyzed .
Seventy - eight ( 69.64 % ) patients were not vaccinated against measles ;
In 85 cases ( 75.89 % ) of adult patients , the rash time was 3 days ( 2 ~ 4 ) and the heat course was 7 days ( 6 ~ 9 ) .
The clinical manifestations were fever ( 100 % ) , rash ( 100 % ) , cough ( 90.18 % ) , nasal discharge ( 85.71 % ) , conjunctivitis ( 100 % ) and oral cavity ( 78.57 % ) .
Liver damage was 56 cases ( 50 % ) , 8 months 2 cases ( 3.57 % ) , 18 years old 51 cases ( 91.07 % ) , the difference was statistically significant ( P0.01 ) . The COX regression model suggested that whether the patients with measles accompanied pneumonia were independent risk factors ( P0.01 ) . 2 . Immunologic and virological characteristics of measles patients : CD4 + IL17 + , CD4 + IFN緯 + and CD8 + IFN緯 + T lymphocytes in adult measles patients were lower than those in the control group ( P0.05 ) .
The percentage of CD8 + IL22 + cells in patients with acute measles was significantly higher than that in control group ( P0.05 ) .
Conclusion 1 . Among 112 patients , the incidence of pneumonia in 18 years of age is high ( 48.65 % ) , and the incidence of liver damage in adult patients with measles is high ( 60.00 % ) . Pneumonia is an independent risk factor affecting the overall course of measles . The total number of lymphocytes in the patients with measles decreased and the number of CD4 + T lymphocytes decreased and CD8 + T lymphocytes increased .
In acute phase , CD8 + IL22 + T lymphocytes increased significantly and the recovery period decreased gradually . The proportion of Treg cells in measles patients increased significantly in acute phase and recovery period . In addition , the results suggested that the measles attenuated live vaccine currently in effect can effectively protect the susceptible population .
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R511.1

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本文編號(hào)：1906983