新英格兰杂志封面

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1 Avian Influenza A (H5N1) Infection in Humans The Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5 The writing committee consisted of the following: John H. Beigel, M. D., National Institute of Allergy and Infectious Diseases,NIH, Bethesda, Md.; Jeremy Farrar, D.Phil., Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Aye Maung Han, M.B., B.S., Department of Child Health, Institute of Medicine, Yangon, Myanmar; Frederick G. Hayden, M.D. (rapporteur), University of Virginia, Charlottesville; Randy Hyer, M.D., World Health Organization, Geneva; Menno D. de Jong, M.D., Ph.D., Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Sorasak Lochindarat, M.D., Queen Sirikit National Institute of Child Health, Bangkok, Thailand; Nguyen Thi Kim Tien, M.D., Ph.D., Pasteur Institute, Ho Chi Minh City, Vietnam; Nguyen Tran Hien, M. D., Ph.D., National Institute of Hygiene and Epidemiology, Hanoi; Tran Tinh Hien, M.D., Ph.D., Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Angus Nicoll, M.Sc., Health Protection Agency, London; Sok Touch, M.D., Ministry of Health, Phnom Penh, Cambodia; and Kwok-Yung Yuen, M.D., University of Hong Kong, Hong Kong SAR, China. Address reprint requests to Dr. Hayden at the Department of Internal Medicine, P.O. Box , University of Virginia Health Sciences Center, Charlottesville, VA 22908, or at fgh@virginia.edu. N Engl J Med 2005; 353: Copyright c 2005 Massachusetts Medical Society. H5N1 WHO H5N1 H5N1 1 H5N1 1 H5N H5N1 2,3 4,5 H5N H5N Reprinted from THE NEW ENGLAND JOURNAL OF MEDICINE (ISSN )Vol. 353: (September 29, 2005). Copy right 2005 c Massachuselts Medical Society. All rights reserved. Printed in CHINA, Tel: (8610) Fax: (8610)

2 WHO * * 2 * 1997 MN,ELISA,WB 51 6(12) 6 Katz (4) MN,WB 293 9(3) 1 Bridges MN,WB 1525 Bridges 7 10% 1997 MN,WB (4) 2 Buxton Bridges MN MN MN Liem MN,RT PCR 60 0 Schultsz Apisarntha- narak MN ,

3 3 * (N=18) (N=17) (N=10) (N=10) (N=4) ~60 2~58 5~24 6~35 8~28 % 8(44) 9(53) 6(60) 3(30) 1(25) NS 4 3 NS NS 2~8 2~ /16(70) 14/17(82) 8/9(89) 6/6(100) 3/4(75) / % 4 3 NS ~7 3~8 4~7 5~8 % >38 17/18(94) 17/17(100) 10/10(100) 10/10(100) 4/4(100) 4/18(22) NS NS 1/10(10) 4/4(100) 2/18(11) 9/17(53) 0 2/10(20) NS 3/18(17) 7/17(41) 7/10(70) NS 2/4(50) 3/18(17) 4/17(24) NS NS 2/4(50) 6/18(33) 4/17(24) NS 1/10(10) 0 12/18(67) 16/17(94) 10/10(100) 10/10(100) 4/4(100) NS 13/17(76) 5/10(50) 3/10(30) NS 4/12(33) 12/17(71) 0 0 1/4(25) 7/12(58) 9/17(53) 0 0 NS 1/18(6) 13/17(76) 10/10(100) 10/10(100) NS 11/18(61) 17/17(100) 10/10(100) 10/10(100) 4/4(100) 11/18(61) 7/12(58) NS 8/10(80) 1/2(50) NS 4/12(33) NS 8/10(80) 1/2(50) 11/18(61) 8/12(67) 5/6(83) 7/10(70) NS H5N RT-PCR

4 3 ( ) (N=18) (N=17) (N=10) (N=10) (N=4) (%) 8(44) 13(76) 9(90) 7(70) 4(100) NS 7(41) NS 0 NS 4(22) 5(29) 1(10) 2(20) NS 10(56) NS 1(6) 0 2(20) (59) 5(50) 10(100) ** 5(28) 8(47) 7(70) 5(50) NS NS 8(47) 2(20) NS ~29 9~30 4~17 4~21 6~10 (%) 6(33) 12(71) 8(80) 8(80) 4(100) 10, H5N1 H5N1

5 12,21,22 3 ARDS 15 ARDS 6 H5N1 4~ ~ , , ~5 8~17 Reye 21 > H5N1 23 H7 15 H5N ,16 6~ , ~16 15 H5 RNA H5N1 26 H5N1 RNA 7 3~17 RNA ~ ~8 H5N1 H3N2 H1N1 10

6 27 H5N1 Z RT-PCR 2 4~18 H5N H5N1 15, H5N ,15, ~ ~16 27 RNA 9 7 RNA Glu627Lys 28,29 28,29,39,40 1 4~9 Asp92Glu 6 RNA 1 TNF RNA TNF H5N1 35,36 37,38 17,18 H5N1 39,40

7 H5N TNF ~ Simmons C 3 ARDS 10~14 H5N1 27, ,15,27,42 H5N1 H5N1 4 H5N1 H5N1 H5N1 H5N1 RNA H5N1 RNA PCR H5 H H5N1 5 1 SARS H5N1 46,47

8 4 * H5 7~ H5 7~14, H , kg 30 mg 15~23 kg 45 mg ~40 kg 60 mg >40 kg 75 mg H5N mg 2 7~10 N1 His274Tyr 15 51,52 53 H1N mg H1N1

9 1 NIOSH N-95 2 >38 75 mg 1 7~ mg 1 7~10 > *

10 54 peramivir H5N1 M2 peramivir ARDS 4 H5 H MF H ( ) H H5N ( ) 4,5 SARS N95 75 mg 1 7~ H5N1 H5N1 5 1 H5N1 H5N1 H5N1 H5N1

11 M2 H5N1

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