人感染新亚型流感影像诊断专家共识

doi:10.19871/j.cnki.xfcrbzz.2025.05.017

摘要/Abstract

摘要： 新亚型流感病毒可通过呼吸道吸入、直接接触等途径侵入人体,其中肺部是最常见的发病部位。近年来,人感染新亚型流感病例在我国呈局部散发态势,在原有病毒亚型的基础上,新的亚型不断出现,比如H7N4、H9N2、H10N8和H10N3等亚型,人感染新亚型流感成为威胁人类健康的重要公共卫生问题。影像学在人感染新亚型流感的早期诊断、鉴别诊断及疗效评价中发挥着重要的作用。为了推动我国人感染新亚型流感影像诊断与治疗工作,结合循证医学的方法学要求,40余位感染病学、影像学、病理学、检验学、免疫学和微生物学等专家共同参与,制订了人感染新亚型流感影像诊断专家共识,形成了7条推荐意见。本共识及推荐意见基于当前最新研究数据,综合临床实际情况,以期为临床医师提供明确的影像诊断依据和选择合适的影像检查方法。

关键词: 人感染新亚型流感, 新亚型流感病毒, 肺炎, 影像学, 体层摄影术, 计算机断层扫描, 专家共识

Abstract: Avian influenza virus infects humans through various pathways such as respiratory tract or direct contact, with the lungs being the most common site of the disease. In recent years, cases of human infection with avian influenza appeared sporadically in China, with new subtypes constantly emerging, such as H7N4, H9N2, H10N8, and H10N3. Human infection with avian influenza has become a significant public health issue threatening human health. Imaging plays an important role in the early diagnosis of human infection with avian influenza. In order to promote the standardization of imaging diagnosis and treatment for human infection with avian influenza in China, experts in the fields of infectious diseases, radiology, pathology, and laboratory medicine have collaboratively developed an expert consensus on imaging diagnosis, including 7 recommendations. The consensus is based on the latest research data and clinical practice to form imaging diagnosis recommendations, aim to provide clear Imaging diagnostic suggestions for clinicians.

Key words: Human infection with avian influenza, Avian influenza virus, Pneumonia, Imaging, Tomography, Computed tomography, Expert consensus

中图分类号:

R511
R445

中国研究型医院学会感染与炎症放射学专业委员会, Radiology Science编辑部, Radiology of Infectious Diseases编辑部, 《新发传染病电子杂志》编辑部. 人感染新亚型流感影像诊断专家共识[J]. 新发传染病电子杂志, 2025, 10(5): 91-99.

China Research Hospital Society, Specialty Committee of Infectious, Inflammatory Radiology, Radiology Science Editorial Department, Radiology of Infectious Diseases Editorial Department, Electronic Journal of Emerging Infectious Diseases Editorial Department. Expert consensus on imaging diagnosis of human infection with avian influenza[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(5): 91-99.

参考文献

[1] 国家卫生健康委员会办公厅, 国家中医药管理局综合司. 人感染禽流感诊疗方案(2024年版)[J]. 中国病毒病杂志, 2024, 14(5):411-415.
[2] 韩冰, 蒋荣猛. 《人感染禽流感诊疗方案(2024年版)》解读[J/CD]. 新发传染病电子杂志, 2024, 9(5):94-97.
[3] FOUCHIER RAM, MUNSTER V, WALLENSTEN A, et al.Characterization of a Novel Influenza A Virus Hemagglutinin Subtype (H16) Obtained from Black-Headed Gulls[J]. J Virol, 2005, 79(5):2814-2822.
[4] OLSEN B, MUNSTER VJ, WALLENSTEN A, et al.Global patterns of influenza a virus in wild birds[J]. Science, 2006, 312:384-388.
[5] LIANG Y.Pathogenicity and virulence of influenza[J]. Virulence, 2023, 14(1):2223057.
[6] FERGUSON NM, FRASER C, DONNELLY CA, et al.Public health risk from the avian H5N1 influenza epidemic[J]. Science, 2004, 304(5673):968-969.
[7] TRAN TH, NGUYEN TL, NGUYEN TD, et al.Avian influenza A (H5N1) in 10 patients in Vietnam[J]. N Engl J Med, 2004, 350(12):1179-1188.
[8] YANG Z, MOK CKP, PEIRIS JSM, et al.Human Infection with a Novel Avian Influenza A(H5N6) Virus[J]. N Engl J Med, 2015, 373(5):487-489.
[9] GAO R, CAO B, HU Y, et al.Human infection with a novel avian-origin influenza A (H7N9) virus[J]. N Engl J Med, 2013, 368(20):1888-1897.
[10] 童学成, 武幸, 薛峰, 等. 全球首例人感染H7N4禽流感临床救治分析[J]. 中华传染病杂志, 2018, 36(3):129-132.
[11] 金秋燕, 张璐西, 杨磊, 等. 全球首例人感染H7N4禽流感病毒性肺炎的CT表现[J/CD]. 新发传染病电子杂志, 2018, 3(1):45-48.
[12] 侯文忠, 张倩倩, 罗彩梅, 等. 全球首例人感染H9N2亚型禽流感病毒肺炎的临床影像学描述性研究[J/CD]. 新发传染病电子杂志, 2016, 1(1):18-22.
[13] 万建国, 张晋湘, 陶文强, 等. 全球首例甲型H10N8禽流感病毒感染导致重症肺炎死亡病例分析[J]. 中华危重病急救医学, 2014, 26(2):120-122.
[14] JING J, WANG L, WANG G, et al.A human infection case with avian-origin H10N3 influenza virus[J]. Quant Imaging Med Surg, 2021, 11(10):4508-4510.
[15] 谭仕稷, 韦静, 刘升, 等. 广西首例人感染H10N3禽流感合并重度急性呼吸窘迫综合征患者静脉-静脉体外膜肺氧合治疗策略探析并文献复习[J/CD]. 新发传染病电子杂志, 2025, 10(2):1-6.
[16] 李敏媛, 单秋兰, 张乐, 等. 人感染甲型H10N3禽流感病毒肺炎的影像学表现与病理机制分析-附2例报告[J/CD]. 新发传染病电子杂志, 2025, 10(2):7-13.
[17] BURKI T.Risk of highly pathogenic avian influenza to humans[J]. Lancet Infect Dis, 2023, 23(9):e343-e344.
[18] WORLD HEALTH ORGANIZATION. WHO Avian Influenza Weekly Update Number 992 4 April2025[EB/OL].[2025-04-04]. https://cdn.who.int/media/docs/default-source/wpro---documents/emergency/surveillance/avian-influenza/ai_20250404.pdf?sfvrsn=f6532268_1&download=true.
[19] VAZQUEZ-PEREZ JA, WONG-ARAMBULA C, SOLIS-HERNANDEZ M, et al.Mexico's Laboratory-Confirmed Human Case of Infection with the Influenza A(H5N2) Virus[J]. Viruses, 2025, 17(2):205.
[20] DUONG MH, PHAN T, NGUYEN TH, et al.Human Infection with Avian Influenza A(H9N2) Virus, Vietnam, April 2024[J]. Emerg Infect Dis, 2025, 31(2):388-392.
[21] TAN M, ZENG X, XIE Y, et al.Reported human infections of H9N2 avian influenza virus in China in 2021[J]. Front Public Health, 2023, 11:1-10.
[22] VENKATESAN P.Human cases of avian influenza A(H5) in the USA[J]. Lancet Microbe, 2024, 5(11):100978.
[23] 黄煌, 潘越峻, 张文先, 等. 人感染H7N9禽流行性感冒17例患者的临床特征和救治分析[J]. 中华传染病杂志, 2014, 32(12):735-739.
[24] QUN L, LEI Z, MINGHAO Z, et al.Epidemiology of human infections with avian influenza A(H7N9) virus in China[J]. N Engl J Med, 2014, 370(6):520-532.
[25] GAO HN, LU HZ, CAO B, et al.Clinical findings in 111 cases of influenza A (H7N9) virus infection[J]. N Engl J Med, 2013, 368(24):2277-2285.
[26] MEIJER WJ, LINN FH, WENSING AM, et al.Acute influenza virus-associated encephalitis and encephalopathy in adults:a challenging diagnosis[J]. JMM Case Rep, 2016, 3(6):e005076.
[27] MAK GCK, KWAN MY, MOK CKP, et al.Influenza A(H5N1)Virus infection in a child with encephalitis complicated by obstructive hydrocephalus[J]. Clin Infect Dis, 2018, 1(66):136-139.
[28] XIA JB, ZHU J, HU J, et al.H7N9 influenza A-induced pneumonia associated with acute myelitis in an adult[J]. Intern Med, 2014, 53(10):1093-1095.
[29] KIM MJ, OH MJ.Eosinophilic Enteritis Presenting as Massive Ascites after Influenza A Virus Infection in a Young Female[J]. Korean J Gastroenterol, 2019, 74(3):163-167.
[30] SOUSOU J, KARAN A, TAYLOR M, et al.An unusual case influenza A-induced empyema from Pseudomonas aeruginosa[J]. CHEST, 2024, 166(4):A1387-A1388.
[31] 张常然, 牛媛媛, 林建聪, 等. 建立实时荧光定量PCR技术检测H5N1型高致病力禽流感病毒[J]. 中华检验医学杂志, 2009, 32(1):68-71.
[32] TAUBENBERGER JK, MORENS DM.The Pathology of Influenza Virus Infections[J]. Annu Rev Pathol, 2008, 3(1):499-522.
[33] FLERLAGE T, BOYD DF, MELIOPOULOS V, et al.Influenza virus and SARS-CoV-2:pathogenesis and host responses in the respiratory tract[J]. Nat Rev Microbiol, 2021, 19(7):425-441.
[34] GU J, XIE Z, GAO Z, et al.H5N1 infection of the respiratory tract and beyond:a molecular pathology study[J]. Lancet, 2007, 370(9593):1137-1145.
[35] TERRACCIANO L, BROZEK J, COMPALATI E, et al.GRADE system:new paradigm[J]. Curr Opin Allergy Clin Immunol, 2010, 10(4):377-383.
[36] 沈鹏, 宗酉明, 殳儆, 等. 超声在评估人感染H7N9禽流感肺部病变中的应用[J]. 中华急诊医学杂志, 2014, 23(2):224-226.
[37] 刘莹, 蔡水江, 黄煌, 等. 肺部超声在重症人感染H7N9禽流感中的应用研究[J]. 中国医药科学, 2018,8(05):13-15.
[38] ZHANG YK, LI J, YANG JP, et al.Lung ultrasonography for the diagnosis of 11 patients with acute respiratory distress syndrome due to bird flu H7N9 infection[J]. Virol J, 2015, 12:176.
[39] 李莉, 李宏军, 赵晶, 等. 13例人感染H7N9禽流感的胸部影像特点[J]. 放射学实践, 2014, 29(7):748-750.
[40] DAI J, ZHOU X, DONG D, et al.Human infection with a novel avian-origin influenza A (H7N9) virus:serial chest radiographic and CT findings[J]. Chin Med J (Engl), 2014, 127(12):2206-2211.
[41] 汪洋, 周竹萍, 张英炜, 等. 人感染H7N9禽流感的临床与影像学特征[J]. 中华放射学杂志, 2013,47(9):780-782.
[42] CHOE J, LEE SM, HWANG HJ, et al.Artificial Intelligence in Lung Imaging[J]. Semin Respir Crit Care Med, 2022, 43(6):946-960.
[43] 闫瑞峰, 黎金葵, 王帅文, 等. 人工智能辅助诊断系统在新型冠状病毒感染肺部病变中的临床应用研究[J]. 兰州大学学报(医学版), 2023, 49(5):51-56.
[44] 朱莹, 张志勇, 施裕新, 等. 人感染H7N9禽流感出院患者的随访研究[J]. 中华放射学杂志, 2013, 47(9):786-789.
[45] 陆普选, 曾政, 郑斐群, 等. 人感染H7N9禽流感病毒性重症肺炎的影像学表现及动态变化特点[J]. 放射学实践, 2014, 29(7):740-744.
[46] XU Q, JIANG F.CT of Human Infection with Avian-Origin Influenza A (H10N3) Virus[J]. Radiology, 2022, 304(3):531.
[47] 陆普选. 全球首发于中国的人禽流感流行病学与临床影像学特点[J/CD]. 新发传染病电子杂志, 2017, 2(2):124-126.
[48] WANG Q, ZHANG Z, SHI Y, et al.Emerging H7N9 influenza A (novel reassortant avian-origin) pneumonia:radiologic findings[J]. Radiology, 2013, 268(3):882-889.
[49] 余文庆, 丁明东, 戴桂红, 等. H7N9禽流感病毒性肺炎15例分析[J]. 中华结核和呼吸杂志, 2018, 41(7):534-538.
[50] 胡粟, 胡春洪, 周小飞, 等. 人感染H7N9禽流感的胸部影像特点[J]. 中华放射学杂志, 2013, 47(9):775-777.
[51] 童照威, 王伟洪, 李盛利, 等. 人感染H7N9禽流感临床特征及影像学分析[J]. 中华放射学杂志, 2013, 47(9):834-835.
[52] 徐颖, 顾勤, 刘宁, 等. 人感染H7N9禽流感重症肺炎患者肺部影像学特征与动态变化[J]. 中华危重病急救医学, 2015, 27(10):850-852.
[53] CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1) - United States, May-August 2009[J]. MMWR Morb Mortal Wkly Rep, 2009, 58(38):1071-1074.
[54] 李云芳, 李宏军. 人感染H7N9禽流感病毒的胸部影像学表现[J]. 放射学实践, 2014, 29(7):745-747.
[55] 邓莹莹, 黄华, 袁静, 等. 人感染H7N9禽流感病毒性肺炎临床影像学诊断及疗效评价[J/CD]. 新发传染病电子杂志, 2017, 2(1):46-49.
[56] 颜骏, 吉木森, 刘竞, 等. 妊娠合并H7N9禽流感一例[J]. 中华结核和呼吸杂志, 2014, 37(2):139-140.
[57] ZHANG L, LIU K, SU Q, et al.Clinical features of the first critical case of acute encephalitis caused by the avian influenza A (H5N6) virus[J]. Emerg Microbes Infect, 2022, 11(1):2437-2446.
[58] OSTROWSKY B, HUANG A, TERRY W, et al.Low pathogenic avian influenza A (H7N2) virus infection in immunocompromised adult, New York, USA, 2003[J]. Emerg Infect Dis, 2012, 18(7):1128-1131.
[59] ZHUANG Y, WANG M, LIANG L, et al.First Known Human Death After Infection With the Avian Influenza A/H3N8 Virus: Guangdong Province, China, March 2023[J]. Clin Infect Dis, 2024, 78(3):646-650.
[60] PEREIRO T, LOURIDO T, RICOY J, et al.Influenza Virus, Herpes Simplex Virus and Methicillin-Resistant Staphylococcus aureus Coinfection in an Immunocompetent Patient[J]. Arch Bronconeumol (Engl Ed), 2018, 3(54):159-160.
[61] ARCANGELETTI MC, DE CONTO F, MONTECCHINI S, et al.A rare case of SARS-CoV-2 and influenza A virus super-infection[J]. Diagn Microbiol Infect Dis, 2022, 104(1):115743.
[62] LIU M, ZENG W, WEN Y, et al.COVID-19 pneumonia:CT findings of 122 patients and differentiation from influenza pneumonia[J]. Eur Radiol, 2020, 30(10):5463-5469.
[63] 赵顺英, 钱素云, 陈志敏, 等. 儿童肺炎支原体肺炎诊疗指南(2023年版)[J/CD]. 新发传染病电子杂志, 2024, 9(1):73-79.
[64] 马帅, 温浦钲, 康丽惠, 等. 儿童肺炎支原体肺炎的临床及影像学特征分析[J/CD]. 新发传染病电子杂志, 2024, 9(1):7-11.
[65] ANTONIO GE, OOI CG, WONG KT, et al.Radiographic-clinical correlation in severe acute respiratory syndrome:study of 1373 patients in Hong Kong[J]. Radiology, 2005, 237(3):1081-1090.
[66] CHUNG M, BERNHEIM A, MEI X, et al.CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)[J]. Radiology, 2020, 295(1):202-207.
[67] HUANG Y, JIANG Y, LI Z, et al.Comparison of initial high-resolution computed tomography (HRCT) features of coronavirus disease 2019 (COVID-19) pneumonia and other viral pneumonias[J]. Ann Palliat Med, 2021, 10(1):560.
[68] GU B, YAO L, ZHU X, et al.Comparison of hospitalized patients with severe pneumonia caused by COVID-19 and influenza A (H7N9 and H1N1):A retrospective study from a designated hospital[J]. Open Med (Wars), 2022,17(1):1965-1972.
[69] 国家卫生健康委员会, 国家中医药管理局. 儿童腺病毒肺炎诊疗规范(2019年版)[J]. 传染病信息, 2019, 32(4):293-298.
[70] 贾春阳, 时胜利. 儿童腺病毒肺炎胸部CT表现与临床特点分析[J]. 临床放射学杂志, 2023, 42(3):472-476.
[71] KOO H J, LIM S, CHOE J, et al.Radiographic and CT Features of Viral Pneumonia[J]. Radiographics, 2018, 38(3):719-739.