(CIP) /. :, 2005 ISBN 7 200 06332 0.... R511. 7 62 CI P (2005) 148226 : : : : : LIU GA N FA NGZHI S H OUCE * ( 6 ) : 100011 : www.bph.com.cn * 140 203 32 2. 25 40 2006 1 1 2006 1 1 1 10 000 ISBN 7 200 06332 0/ R 341 : 3. 80 : 010-58572393 : ( 010) 62013123 : ( 010) 62361304 : ( 010 ) 58572288 : keji@ bphg. com. cn
6 ( 10% ), 300 500, 8% 10% 1997 H5N1,, 30% ( WH O ),,, 2005,,,,,,,,
,,,,
MULU ( 1 ) 1. ( 1 ) 2. ( 1 ) 3. ( 1 ) 4. ( 2 ) 5. ( 3 ) 6. ( 3 ) 7. ( 3 ) 8. ( 4 ) 9. ( 4 ) 10. ( 4 ) 11. ( 5 ) 12. ( 5 ) 13. ( 6 ) 14. 2005 ( 7 ) 15. ( 7 ) ( 8 ) 16. ( 8 ) 17. ( 8 ) 18. ( 9 ) 1
19. ( 9 ) 20. ( 10 ) 21. H N H ( 10 ) 22. H N N ( 10 ) 23. ( NP ) ( 11 ) 24. M1 M2 ( 11 ) 25. ( 12 ) 26. ( 12 ) 27. ( 13 ) 28. ( 13 ) 29. (14) 30. ( 14 ) 31. ( 15 ) 32. ( 15 ) 33. (16) 34. ( 16 ) 35. ( 17 ) 36. ( 17 ) 37. ( 18 ) 38. ( 18 ) 39. ( 19 ) 2
( 21 ) 40. ( 21 ) 41. ( 21 ) 42. ( 21 ) 43. ( 21 ) 44. ( 22 ) 45. ( 23 ) 46. ( 23 ) 47. ( 23 ) 48. ( 23 ) 49. ( 24 ) 50. ( 24 ) 51. ( 24 ) ( 25 ) 52. ( 25 ) 53. ( 25 ) 54. ( 25 ) 55. ( 25 ) 56. ( 26 ) 57. ( 26 ) 58. ( 27 ) 59. Reye s ( 27 ) 60. ( 27 ) 61. ( 28 ) 62. ( 28 ) 63. ( 29 ) 3
4 64. ( 29 ) 65. ( 30 ) 66. ( 30 ) 67. ( 30 ) 68. ( 31 ) 69. ( 31 ) 70. ( 31 ) 71. ( 31 ) 72. ( 32 ) 73. ( 32 ) 74. ( 33 ) 75. ( 33 ) 76. ( 33 ) 77. ( 34 ) 78. ( 34 ) 79. ( 35 ) ( 36 ) 80. ( 36 ) 81. ( 36 ) 82. ( 36 ) 83. ( 37 ) 84. ( 37 ) 85.? ( 37 ) 86. ( 39 ) 87. ( 39 )
88. ( 40 ) 89. ( 40 ) 90. ( 40 ) 91. ( 41 ) 92. ( 41 ) 93. ( 41 ) 94. ( 42 ) 95. ( 44 ) 96. ( 44 ) 97. ( 45 ) 98. ( 46 ) 99. ( 47 ) 100. ( 47 ) 101. ( 49 ) 102. ( 49 ) 103. ( 49 ) 104. ( 50 ) 105. ( 51 ) ( 52 ) 106. ( 52 ) 107. ( 52 ) 108. ( 53 ) 109. ( 53 ) 110. ( 53 ) 111. ( 53 ) 5
112. ( 54 ) 113. ( 55 ) 114. ( 55 ) 115.? ( 55 ) 116. ( 56 ) 117. ( 56 ) 118.? ( 56 ) 119. ( 57 ) 120. ( 57 ) 121. ( 58 ) 6
1. ( ) ( ),,, ( ),, 2. ( ) ( H5N1, H9N2),, H5N1,, 30% 3.,, 1
2,,,,,,,,,,,,,,,,,,,, 4., (, ) 412, 1933,,, 1580, 30, 5, 1918 1919 1946 1947 1957 1958 1968 1969 1977 5 :,
5., : ;, ;,, :, 6. 1918 1957 1918,, 2100, (850 ),, 6,, 1957, ( 1956 ), 10% 30%,, 0. 25% 7.,,, 3
36, ;,,,, 8., 2005 8,,,,, 9. 1957 1968 1977,,,,,, :,,,,, 4 10.,,
,,,, 30 50, 20% 30%, 70% 80% 11., 1, 50, 1957 1958,, 50%,, 1000 19,, 12., 1948, 80 110, 1957 1968 1977 1997 H5N1 1988, 5
1952, 1957 ( NIC),, 1981, ( CDC) ( NIID) 2000, 23,,,,,,,,,,, 13. 2005 9 28, ( ),,, ( ) ( ) ( ) ( ),, 6
14. 20 05, 2005 4 8,,, 3 ( H3N2 ),, 29,, 3 ( H3N2),, 2005, 15. 1997 5,, H5N1, 2005 11 16, H5N1,, 2005 11 18, 244, 75 7
16. 1933,,, RN A, 8 RN A, 10, 80 120nm,, ( A B C ),,, ( P1 P2 P3), ( M1 M2 ), ( H ) ( N ),,, ;,,, 17. 8 ( NP ) ( M1 ),
, H * N *, H5N1 H1N1,,, H N, H 15, N 9,, 135,, 18. ( A B C ),, 2 3,,,,,,,, ;,, 1918 5 19., 9
20., : / / / ( ) / / 262/ 95 ( H1N1) 21. H N H H RNA 4,, H,, H, H 15, 3 H H, ;,, ; ;, H, 22. H N N 10 N RN A 6, N 9, N 2 N,,
,,, ;, N,, H 23. ( N P ) ( NP ) 5 NP RN A,,,,, 24. M1 M2 M1, 40 % M1, M1,, M1 M2, H, ph, ph, H 11
, H, M2, M2, 25.,,, /,, ( antigenic shift), ; ( antigenic drift),,, 1968 H N 12 26. : (N H ), 30 40 ; ( N, H ), 10 ; ( ) ( N H ),,,, ( )
27. RNA, 8, 7 2 2,, 8, 28. H N H1 H2 H3, N1 N2,,, 1946 1957 H1N1, 1957 1968 H2N2 1968 7 H3N2, 1972 H3N2,,, H3N2 1976 H1N1, H1N1, ( ) Web st er RG 1993 : 8 RNA, H1N1 H1N1, 13
29.,?, RNA,, H2N2 H3N2, 1918,,, 2000,,, 1950 H1N1 27, 1977, 14 30. 1918 1919 H1N1, 1957 H2N2 1977 1, 1 3, 1 3 H1N1, H1N1 1977 1995,
5 ( 1981 1983 1985 1986 1995 ) 1990 1993 H1N1 / / 1/ 86, / / 1/ 86 7, 1992, H1N1, 1995, / / 262/ 95,, 1977 5 H1N1 31.,,,,,,,,,,,,,, 32.,,,,,, 15
,,, 33.,, 14 H 9 N ; 3 H 2 N 14 H 9 N ; H1N1 N3N2, ; H3N8 H7N7 16 34.,,,, H1 H2 H3, H5 H7 H9,,,, 1997, 2004 200, 40 H5N1
, H5N1, H7N7 H9N2 35.,,,?, H5N1 1997, 1998 2000 H9N2, 2003 H7N7 H, 36.,, 1 10 0. 2, 8 4 8 10, 6 6, H, N H5 H7 ( H4 ) 17
37. 8 RNA,, RN A RN A,,,,,, ;,,,, 1983 1994, H5 18 38. ( 10 m),,,, ( ),,,,,,,,,
,,,,,,, 39., 4 5,,, 2,,,,,,,,,,,,,,, 5 19
, 7 8, 15, ; 20
40. 5 1, 2 41.,,,,, 42. 7,, 3, 43., (1 ) :,,, 21
22,, (2 ) :,, (3 ) :,,,,,,,, (4 ) :, (5 ) :,,,,,,, 44.,,,, 10 15, 2 3
, 45., 10 ; 100 167, 6,,,, 20, 6 12 46., 11 3 ;, 47.,,,,,,,,,,,,,,, 48.,,, 23
, 25 000, 36 000 45 000 49.,,, 50., ( ) ( ),,,,, 51.,, : (1 ) :, (2 ) :,,, 24
52. 1 3, 7,, 3, 53.,,,,,,,,,, 1 2, 3 4, 1 2 54. :, 55., 25
,, 1 2,,,,,, 3 4,,, 56.,,, 26 57. : (1 ) :,,, (2 ) :,, 2 4,,,,,,,,,
, (3 ) :,,,,,, 58., : Reye s,,, 59. R e ye s Reye s 2 16,,,,,,,,,,, 60. ( Toxic Shock Syndrome, T SS ) 27
,,,,,,,,,, 61. ( Rhabdomyolysis ),, ; ;, ; 62.,,, 28
63., : (1 ) : 3 (2 ) :, (3 ) : 4 4 ;,, 64. (1 ) :,,, (2 ) :,,, 29
(3 ) : ; ; 4 4 ; ; 1 30 65.,, 66.,,,, ( ), 67.,,,,,,,,,, ( 39 40 ), 3 4,
, 2 3, 68.,,,,,,,, 2 3 4 69.,,,, 70. 39, :,, /, 71.,, 31
,,,, 60, 30%,, 40% 50%,,, ( A- merican Lu ng Association ), 65, 72.,,, 30% 40%,,,, 3,,,,,,, 73. 32 :, ;,
,, 3 74. H5N1, 1 7, 2 4 75. H9N2, ; H7N7 ; H5N1,,,, 39,, 76., 5 48,,, 33
( MODS ),, 77. : (1 ) 1 (2 ) (3 ) (4 ) (5 ) 34 78. ( 2005 ), : (1 ) :, 1 (2 ) :, M1 NP (3 ) :,,, (4 ) :,,,, 4 4
79. H9N2 H7N7 H7N2 H7N3, H5N1,, 30% 35
80.,,,,,,, ( 48 ), 81.,,, 82. 36,,,,,,, Reye s,,,,,,,
, 83.,,,,, 84.,, 1 2,,, 85.? : (1 ) M2 : M2, ( 48 ) M2,,,, H5N1 ( amantadine ) ( rimantadine) :, 100 200mg, 2, 5 ; 1 9 5 mg/ kg, 2, 150 mg, 1, 37
38 14%,,,,,,, 24 36,, (2 ) :,, (48 ),, ( oseltamivir, ),,, H5N1 H9N2,, 150 mg, 3 mg/ kg, 2, 5, 2 75 mg,, 7, 2 (zanamivir ), 2
12, : 10 mg, 2, 5 mg, 12, 5,, 5, peramivir ( BCX 1812, RWJ 270201 ), 146,, 5,,,,, 86. ( ribavirin),, 400 1000 mg, 10 mg/ kg, 4, 7 500 1000 mg, 10 15 mg/ kg, 2, 3 7,, 87.,, 39
88.,,, 89.,, H5N1, X, ( SpO2 ),,,, 5 L/ min ( 40% ), SpO2 < 93 %,,, SpO2 93%, 30 /,, 90.,,,,,, 40
91.,,,,, 24,,,,,, 92.,, (A RDS ),,,,, 93.,,,,,, 41
94. 42, ( 2005 ), (1 ) :,,,,,,,, :,, :, : 10g 12g 6g 10g 10g 15g 15g 10g 15 g 6g : ; (2 ) :,,,,,,,,, :,, :, : 20g 10g 6g 30g 10g 10g 10g 6g 15g
10g 20g : ; (3 ) :,,,,,,,,,, :,,, ;,, :, : 9g 30g 10g 10g 10g 10g 15g 15g 15g 10g 10g 10g :,,, ; ;, (4 ) :,,,,,, :,,, : : 15g 15g 10g 43
10g 10g 30g 6g : ;,,, 95., (1 ) : (2 ) : ( ) (3 ) : ( ) ( ) (4 ) : ( ) (5 ) : (6 ) : 96. 44, :
,,,,,,,,,,,,,,,,, 97.,, 90%,,,,,,,, 45
46, 15 30,,,,,,, 12,,,,,, 98.,,,,,,,,,,,,,,
, Reye s,,,,, 3, 99.,,,,,,,, 60, 300,,,,,,,,,,,,,,,,,, 100.,,, 47
48,,,,,,,,,,,,,,,,,,,,,,,,,,, 4,,, 32,,,, 20% 40%,,,
101.,,,,,,,,,, ( 39 ),,,, 102.,,,,,, C E,,, 103.,,, 49
50,,,,,,,,,,, 104.,,,,,, E C,,,,,,,,,,,,
105.,,,,,,,,,,,,,,,,,,,,,,,, 51
52 106. : (1 ) :,, (2 ) : ( ),,,, (3) : 60,,,, 107.,,,,,,,,,
108.,,, 30 40,,, 109.,,, 3,, 110.,,,,,,,,,,, 111. 53
54,, 50, 30, 30, 15, 5, 112. ( 2005 ) : (1 ),, (2 ), (3 ),, (4 ),,,,, 48 (5 )
( SARS ) (6 ),, (7 ),, ;, (8 ) :,, 113.,,, ;, 114.,, 115.? : 1 3 55
,,, 12, 116., 6 : 60,, ;,,,,, ; 3 117. : ; ; 3 ; ; ; ; 118.? 56 1 2 9 11
,,, 2005 2006 : / / 20/ 99 ( H1N1 ) ; / / 7/ 2004 ( H2N2 ) ; / / 361/ 2002 119.,, : (1 ) :, (2 ) :,, 120., 1,, 57
121. 56 30, 60 10, 65 70,, 1, 40 48,,, ( ), 58