2010年 · 第33卷第06期

Since the spring of 2003, respiratory viral infectious diseases, which constitute "public health events", have often occurred under the harmonious and favorable situation of "peace and peace", which threatens people's health, life and social stability. These infectious diseases mainly include SARS, highly pathogenic human avian influenza A (H5N1) and novel influenza A (H1N1). Today, we should conscientiously draw lessons learned and better face the challenges that may come again in the future.

Japanese scholar Fujimura et al.^[1]The concept of "atopic cough (AC)" was first proposed in 1992, and it was found that AC accounted for 58.3% of patients with chronic dry cough in respiratory specialists^[2]。 AC is a chronic dry cough that is ineffective for bronchodilator treatment, and patients usually have an allergic constitution; Increased cough sensitivity without airway hyperresponsiveness; AC belongs to allergic airway inflammatory disease, pathologically characterized by eosinophilic tracheobronchitis, with the presence of increased eosinophils in airway secretions, thus sputum or induced sputum cytological examination of increased eosinophils. The eosinophilic inflammation of AC was mainly confined to the large airways, and there was no eosinophilic inflammation of the peripheral airways, so there was no eosinophilia in the bronchoalveolar lavage fluid^[3]。

The question about the diagnostic criteria of allergic cough raised by Dr. Xu Juan has indeed caused confusion among many respiratory specialists. Here, the author will give a brief explanation. atopic cough (AC) is one of the main causes of chronic cough in Japan. The simplified diagnostic criteria for allergic cough formulated by the Japan Respiratory Society^[1]Comprises the following steps: (1) dry cough for more than 3 weeks without wheezing or dyspnea; (2) no response to bronchodilator therapy; (3) Inducing eosinophilia in sputum, or having one or more atopic indications: ① history of allergic diseases other than bronchial asthma, ② peripheral blood eosinophilia, ③ serum total IgE increased, ④ specific IgE positive, ⑤ allergen skin test positive; (4) Cough can be relieved after treatment with antihistamines and/or glucocorticoids. Therefore, the definition of AC in the Japanese guidelines covers both patients with non-bronchial asthmatic eosinophil bronchitis (EB) and induced sputum eosinophil normalization. So far, the definition of allergic cough has not been recognized by other societies except Japan and China, and the cough guidelines of American Association of Chest Physicians (ACCP) and other European and American countries^[2]AC is also not listed as the cause of chronic cough. Although AC is proposed as the cause of chronic cough in China, the definition in China is different from that in Japan, and EB is not included in AC. Guidelines for diagnosis and treatment of cough in China^[3]The proposed diagnostic criteria for AC do not include conditions that induce sputum eosinophilia, which is the greatest difference from the diagnostic criteria in Japan.

Since the new type of influenza A (H1N1) (referred to as influenza A) was reported in April 2009, the epidemic has spread rapidly worldwide. The disease is mainly characterized by flu-like symptoms such as fever, cough, sore throat, runny nose, headache, muscle soreness, general discomfort and gastrointestinal discomfort, and the severity of the disease varies^[1]Most patients were self-limiting, and a few patients developed shortness of breath and dyspnea, developed pneumonia or even ARDS and died of multiple organ failure. For most mild patients without comorbidities, rest, drinking more water and symptomatic treatment are adopted, without antiviral drugs and hospitalization. However, in addition to timely antiviral treatment, severe cases should be admitted to intensive care unit for treatment. Therefore, the management of critical cases is the key and difficult point in the clinical treatment of influenza A patients. The literature on clinical management of critical cases of influenza A is reviewed as follows.

The first case of novel influenza A (H1N1) was confirmed in April 2009^[1]。 The virus, which originated in Mexico, has spread to more than 100 countries, including the United States, Canada and China. Pregnant women are at high risk for complications of influenza A^[2]Pregnant women have a 4-fold higher risk of severe influenza A cases and hospitalization than other populations^[3]。 The clinical characteristics, diagnosis and treatment status and prevention of influenza A cases in pregnant women are summarized as follows.

The new type of influenza A (H1N1) (referred to as influenza A for short) is a respiratory infectious disease with clinical characteristics of cough, fever, sore throat and headache. In severe cases, X-ray chest radiographs showed multi-focal infiltration, which rapidly progressed to acute lung injury (ALI), ARDS and renal or multiple organ failure. Recently, the epidemic of influenza A has shown a rapid upward trend around the world, and the prevention and control situation is very severe. The epidemiology, pathology and pathophysiology, diagnosis and treatment of ALI induced by influenza A are reviewed.

Lawrence Joseph Henderson was born on 3 June 1878 in Lynn, Massachusetts, United States, and died on 10 February 1942. He was one of the leading figures in biochemistry at the beginning of the 20th century, not only a renowned physiologist, but also a chemist, biologist, philosopher and sociologist.

Because of the widespread use or even unreasonable abuse of antibacterial drugs, the problems of bacterial resistance and multidrug resistance are becoming more and more serious, especially in respiratory intensive care units. For infections caused by plasmid-mediated cephalosporinase (AmpC enzyme) and extended-spectrum β-lactamase (ESBL) -producing bacteria of Enterobacteriaceae, clinicians often use carbapenem antibacterial drugs as the first choice. This makes the infections caused by gram-negative bacilli producing metallo β-lactamase (BLA blaIMP) frequently occur in recent years, which brings great confusion to clinical anti-infection treatment. Early resistance genes to these metalloenzymes (IMP) were often found in Acinetobacter and Pseudomonas aeruginosa^[1,2]Recently, the Second Affiliated Hospital of Zhejiang University discovered a species of IMP-4-producing acid-producing Klebsiella pneumoniae^[3]In June 2009, we isolated a strain of Klebsiella pneumoniae carrying the IMP-4 resistance gene from tracheal secretion specimens of patients in respiratory intensive care unit. The results of the study confirmed that the resistance gene can be transmitted by plasmid.

dendritic cell (DC) is a specialized antigen-presenting cell in the immune system, which has the potential to initiate and inhibit the body's immune response^[1]。 Immunomodulatory DCs that can encode immunomodulatory factors can be produced by genetic engineering, which has broad prospects for gene-level treatment of transplant rejection, autoimmune response and allergic diseases^[2]。 In this study, mouse interleukin (IL) 10 gene was synthesized by genetic engineering method, and transfected into mouse bone marrow-derived DC to observe its effect on airway inflammation in bronchial asthma (asthma) model, and to explore the feasibility and possible mechanism of intervention in the early stage of asthma (antigen presentation stage) to control asthma.

How to diagnose and treat ARDS early has become an urgent problem for clinicians. We investigated the value of CT in early diagnosis of ARDS by measuring the changes of lung volume in different regions during the course of disease in rabbits with endogenous pulmonary ARDS (ARDSp) and exogenous pulmonary ARDS (ARDSexp) model from May to August 2009, in order to identify, intervene and improve the prognosis of patients with ARDS early.

At present, several gene mutations are known to be related to the resistance of MTB to isoniazid and rifampicin, but there are regional differences in codon mutation rates of different genes. To this end, we examined the mutations of katG and inhA promoters of isoniazid-resistant strains and rpoB of rifampicin-resistant strains in TB patients in Tianjin, and explored the mutation characteristics of drug resistance-related genes and the correlation between gene mutations and drug resistance phenotype.

The patient was a 61-year-old male. Admitted for 1 year of shortness of breath after activity. Pulmonary fibrosis was diagnosed at the local hospital 5 months before admission and was treated with prednisone and acetylcysteine, and his condition was stable. No previous history of diabetes and coronary heart disease, smoking index 40 pack years, and quit smoking for 5 years. Physical examination on admission: Velcro sounds could be heard in the middle and lower parts of both lungs, with the back as the focus; Heart rate 85 beats/min, homogeneous rhythm; Pestle fingers; 380 U/L for lactate dehydrogenase; Arterial blood gas analysis: pH 7.44, PaO₂was 81 mm Hg (1 mm Hg =0.133 kPa), PaCO₂39 mm Hg; Pulmonary function test: vital capacity as % of predicted value 40%, FEV₁is 1.72 L, D_LCO accounted for 63% of the predicted value. High-resolution CT showed mesh shadows in the periphery of both lungs, local honeycomb lungs, and the lower lung base was observed, and massive shadows were observed in the right lower lung (Figure 1)； The BALF was 120 ml, the recovery rate was 53%, and the total number of cells was 43.4×10⁷/L, with 0.78 for macrophages, 0.13 for neutrophils, 0.09 for lymphocytes and 0 for eosinophils. A space-occupying lesion of the right lower lung was diagnosed as squamous cell carcinoma of the lung by fiberoptic bronchoscopy biopsy. The right lower lung lobectomy was performed, the operation time was 88 min, the anesthesia time was 195 min, and the pure oxygen inhalation time was 120 min. The postoperative pathological diagnosis was common interstitial pneumonia complicated with lung squamous cell carcinoma (Figure 2)。 On the 3rd postoperative day, the patient developed dyspnea and progressively worsened with dry cough, without hemoptysis and fever. Arterial blood gas analysis: pH 7.45, PaO₂is 46 mm Hg, PaCO₂42 mm Hg; X-ray chest radiographs showed diffuse exudation in both lungs with ground-glass changes (Figure 3)； Cardiac ultrasonography: Heart structure was normal, ejection fraction was 53%; Antibodies to cytomegalovirus, adenovirus, respiratory syncytial virus and chlamydia were negative. The preliminary clinical diagnosis was acute exacerbation of idiopathic pulmonary fibrosis (IPF), and the symptoms were not relieved after non-invasive positive pressure ventilation and supportive therapy, high-dose pulse therapy with glucocorticoids (methylprednisolone 500 mg, intravenous drip for 3 days) and empirical therapy with antibiotics. On the 4th postoperative day, tracheal intubation and volume-controlled ventilation were given. The tidal volume was 6~8 ml/kg, the exhaled tidal volume was about 0.4 L, and the positive end-expiratory pressure was 8 cm H₂O (1 cm H₂O =0.098 kPa), the inhaled oxygen concentration was 100%, and the peak airway pressure of the patient was maintained at 35 cm H₂O or less, oxygen saturation is 70%; Bronchoalveolar lavage was performed again, BALF was 120 ml, the recovery rate was 47%, and the total number of cells was 19.2×10⁷/L, of which 0.54 for macrophages, 0.45 for neutrophils, 0.01 for lymphocytes, 0 for eosinophils, no bacterial, MTB and fungal growth in BALF culture, and no pneumocystis in silver methylamine staining. Intravenous infusion of methylprednisolone was reduced to 80 mg/12 h on the 6th postoperative day, and anti-infective treatment was continued. The patient had no relief in dyspnea, and blood gas analysis showed no improvement in respiratory failure. He died of cardiac arrest on the 15th postoperative day. The pathology of percutaneous lung puncture after death showed alveolar epithelial cell proliferation, alveolar septum edema and thickening, more spindle myofibroblasts proliferating inside, and the formation of hyaline membrane in the alveoli (Figure 4)。

A 61-year-old male was admitted to the Department of Respiratory Medicine of Hangzhou First People's Hospital on November 14, 2006 due to "cough for one month". The patient developed dry cough and fever one month before admission, and his body temperature fluctuated between 37.5 and 38.2 ℃. He was given amoxicillin and other drugs locally, but his condition did not improve. One week before admission, chest CT examination revealed right lung shadow with cavity, and was admitted to our hospital with the nature of right lung shadow to be investigated. There were no chills, night sweats, fatigue, chest pain, hemoptysis and shortness of breath since the onset of the disease. The patient was treated with "isoniazid, rifampicin and streptomycin" for 8 months due to tuberculosis in the right upper lung 30 years ago. After the lesion was calcified, the drug was stopped. He had no hypertension, diabetes and smoking habit. Personal history and family history are not special. Physical examination: body temperature 36.7 ℃, 20 breaths/min, no skin rash, no superficial lymph node swelling, centered trachea, no deformity of thorax, bilateral equivalence of tactile speech tremor, clear sound of both lungs, no dry and wet rales, heart rate 80 beats/min, no murmur, no touch of liver and spleen, no percussion pain in both kidney areas, no edema in both lower limbs, and no abnormalities in neurological examination. Laboratory tests: There were no abnormalities in blood, urine, stool routine and blood biochemistry, ERS, rheumatoid factor, C-reactive protein and tumor markers were all in the normal range, autoantibody test was negative, sputum was negative for acid-fast bacilli, and lung ventilation function and diffusion function were basically normal; Arterial blood gas analysis: pH 7.39, PaCO₂was 37 mm Hg (1 mm Hg =0.133 kPa), PaO₂90.8 mm Hg; Chest CT scan showed an isolated mass shadow in the dorsal segment of the right lower lung with irregular boundaries. The lateral side was connected to the pleura, and there was a cavity in it. Enhanced CT showed partial enhancement of the lesion, irregular inner and outer walls of the cavity, and no enlarged lymph nodes were seen in the mediastinum (Figure 1，Figure 2)。 No abnormalities were observed under bronchoscopy. Pathological sections after CT-guided puncture biopsy of lung tissue showed multiple and patchy lesions. Embolus packing composed of fibroblasts, fibroblasts and collagen fibers could be seen in the bronchioles and alveolar cavity of the lesions. Lymphocytes and plasma cells were aggregated in the center of the embolus, and plasma cells, lymphocytes and eosinophils were infiltrated in the alveolar septum and around the bronchus (Figure 3，Figure 4)。 Combined with clinical manifestations, bronchiolitis obliterans with organizing pneumonia (BOOP) was diagnosed. After the diagnosis was confirmed, intravenous methylprednisolone 40 mg/d was administered. After 2 weeks, CT was re-examined and the lesions were partially absorbed. Subsequently, oral prednisolone 30 mg/d was administered and the dose was gradually reduced, and the dose was completely absorbed after 4 months.

cryptococcosis is a subacute or chronic deep fungal disease caused by Cryptococcus neoformans infection, which mostly occurs in people with low immune function. In recent years, due to the widespread clinical use of immunosuppressants, glucocorticoids and other drugs or the increase of immunodeficiency (such as AIDS) patients, the incidence of cryptococcosis is on the rise, but it may also occur in people with normal immune function. Cryptococcus mainly invades the human body from the respiratory tract, and the lesions mainly invade the central nervous system, followed by the lungs and skin. Other organs such as digestive tract, kidney, lymph nodes, liver, spleen and bone are less common. Heping Hospital affiliated to Shanxi Changzhi Medical College treated a patient with unexplained recurrent hyperthermia with deep and superficial multiple lymphadenopathy, which was confirmed by right supraclavicular lymph node biopsy as lymph node cryptococcosis. The present report is as follows, and the relevant literature is reviewed, and its clinical and pathological characteristics are analyzed to improve the understanding of this disease.

Risk factors for pulmonary thromboembolism (PTE) include any factor that can cause venous blood stasis, endothelial damage to the venous system, and hypercoagulable blood. Patients with unknown PTE may have antiphospholipid antibody syndrome (APS), which is reported as follows.

A 33-year-old female went to the respiratory department of the Third Affiliated Hospital of Sun Yat-sen University on 23 February 2009 due to "repeated hemoptysis for 6 years and recurrence for 6 days". Six years ago, the patient developed hemoptysis without obvious trigger, which was bright red in color and small in amount. The local hospital planned to diagnose "bronchiectasis" and improved after 1 week of anti-infective treatment. Since then, the symptoms have repeatedly appeared, with hemoptysis once in about 2 to 3 years, and the amount is small, which can be improved by anti-infective treatment. There was no obvious cough or expectoration in the interepisodic period. Six days ago, hemoptysis occurred again without obvious trigger, with a volume of about 15 ml and a bright red color. After that, sputum was coughed up repeatedly with blood in the sputum. There was no fever, chest pain, chest tightness and shortness of breath, nausea, vomiting, headache, dizziness and lower limb edema. The results of chest X-ray examination showed that the texture of both lungs was increased, the edge was blurred, the lung texture of both lower lungs was disproportionately branched, and the right upper lung was cord-like shadow, considering bronchiectasis of both lower lungs; CT of the chest showed signs of irregular filling defect in the lumen of the right lower pulmonary artery, and it was proposed to be diagnosed as "right lower pulmonary artery embolism". Physical examination: The patient was conscious, generally in good condition, breathing smoothly, no abnormalities in the skin and mucous membranes of the whole body, no palpable swelling of superficial lymph nodes, no dry and wet rales in both lungs, and small heart boundaries. The heart rate was 80 beats/min, the heart rhythm was regular, and there was no murmur in the auscultation area of each valve. Physical examination of abdomen and limbs showed no abnormalities. Blood gas analysis was performed after admission: pH 7.43, PaCO₂39.6 mm Hg (1 mm Hg =0.133 kPa), PaO₂100.0 mm Hg, P_(A-A)O₂1.0 mmol/L, SaO₂97.9%。 There were no abnormalities in laboratory tests such as blood routine, liver and kidney function, coagulation function, C-reactive protein and immunological tests. D-dimer 0.74 mg/L. There were no obvious abnormalities in electrocardiogram and color Doppler ultrasound. Arteriovenous color Doppler ultrasound of both lower limbs showed no obvious embolic sonography, and the blood flow was smooth. Bronchoscopy showed mild congestion of the right bronchial mucosa, and the secretion from the right main bronchus was submitted for examination, and the smear and bacterial culture were negative; The left bronchial mucosa is obviously congested, the capillaries are exposed, and it is easy to bleed when touched. 320-slice spiral CT showed: (1) multiple fibrous foci in the right lung, thickening of the right pleura, and mild bronchiectasis in the upper lobe of the right lung; (2) The main trunk of the right pulmonary artery is absent, multiple tortuous arterioles can be seen in the mediastinum and right hilar area, the main trunk of the left pulmonary artery and the left pulmonary vein are thickened, and the right pulmonary vein is small (Figure 1，Figure 2，Figure 3，Figure 4)。 Radionuclide pulmonary ventilation imaging showed: aerosol inhalation⁹⁹Tc^m-Diethylenetriaminepentaacetic acid aerosol imaging after 5 min showed that the right lung volume decreased, the radioactivity inhalation decreased, and the distribution was uneven. The radioactivity in the middle and upper lobes of the right lung decreased significantly, and the radioactivity distribution in the left lung was basically normal. The ventilation indexes of upper, middle and lower lobes of the right lung were 16.1, 11.7 and 10.4, respectively, and those of upper and lower lobes of the left lung were 31.2 and 30.6, respectively. After admission, ceftazidime 3.0 mg was given intravenous drip twice/d, and it improved after 5 days of treatment. There has been no hemoptysis since follow-up.

A 27-year-old male was admitted to the hospital due to "fever, cough for 2 weeks, shortness of breath and chest pain for 1 week". On February 20, 2008, the patient had symptoms such as nasal congestion, runny nose and dry cough without obvious trigger, and was not treated. After 3 days, fever (body temperature not measured) with a small amount of yellow phlegm appeared. The next day, the body temperature was checked at the local hospital at 39 ℃. Blood routine: white blood cells were 24×10⁹/L, neutrophils were 0.81, and anti-infective treatments such as cefpiramide, levofloxacin and amikamycin were ineffective. Laboratory test on 28-Feb-2008: white blood cells 32×10⁹/L, neutrophils 0.78, C-reactive protein 110 mg/L, alanine aminotransferase 96 U/L, aspartate aminotransferase 41 U/L; Chest CT showed consolidation of both lower lungs and a small amount of pleural effusion on both sides (Figure 1，Figure 2)； Bone puncture examination showed leukemia-like reaction, and abdominal B-ultrasound examination showed no abnormality. Switched to meropenem anti-infective therapy with no decrease in body temperature and sometimes a small rash presenting as acne-like changes. On March 3, 2008, he was transferred to the emergency department of our hospital and continued to be treated with meropenem and levofloxacin. He still had fever, shortness of breath and chest pain were further aggravated, accompanied by mild nasal congestion. During the course of the disease, the diet and sleep were poor, the defecation and stool were normal, there was no obvious joint swelling and pain, and there was no weight loss.

Quickly diagnosing and blocking the spread of MDR-TB bacteria is of great significance to control the epidemic of MDR-TB. The growth of Mycobacterium tuberculosis is slow, and traditional drug sensitivity tests based on solid cultures are very time-consuming. New molecular diagnostic methods based on drug resistance mutations will be the development trend of rapid diagnosis. Mycobacterium tuberculosis resistance is associated with point mutations in specific genes on the genome. At present, two rapid diagnostic products based on detection mutations have been approved by WHO. However, due to the different characteristics of drug-resistant mutations in different regions, their sensitivity and specificity of detection in different regions are very different. We observed the characteristics of drug resistance gene mutation of MDR-TB in Shanghai, and screened a set of highly sensitive drug resistance mutation sites for rapid diagnosis of drug-resistant tuberculosis.

On April 1, 2010, dozens of experts and doctors in the field of interventional respiratory diseases in Beijing gathered together to hold the second academic activity of Beijing Interventional Respiratory Disease Collaborative Group. The theme of this academic event is "Thoracoscopy-From Surgery to Internal Medicine". The purpose of this academic event is to discuss the technical operation, clinical application and thoracoscopic pleurodesis in internal medicine. The event was hosted by the Department of Respiratory Medicine of Peking University First Hospital and the Department of Respiratory Medicine of Beijing Chaoyang Hospital.

More than ten years have passed since the author began to try interventional techniques for respiratory diseases. During this period, the technique of interventional respiratory disease developed rapidly, and it has entered the stage of popularization abroad. Although this aspect started late in China, in recent years, with the development of various training courses and the introduction of related technologies in various media, domestic respiratory doctors have gained a certain degree of understanding of these technologies.

Disease management should include finding risk factors, early diagnosis and early intervention to prevent disease progression. However, the management of patients with chronic diseases is full of challenges. For example, disease management of patients with hypertension, heart disease and diabetes can significantly improve the prognosis of patients, but the prognosis of COPD patients managed at the same time has not changed. According to statistics, COPD will be the third leading cause of death in the United States by 2020. In developing countries, the incidence of COPD and the resulting disease burden are expected to increase due to factors such as smoking and the environment^[1]。 Smoking and population aging lead to a rapid increase in the number of COPD cases at present and in the future. The incidence rate of COPD in the general population is 1%, and the incidence rate of COPD in the population over 40 increases rapidly to 8% ~10%^[2]。 The results of a survey of 102 230 adults in rural areas in northern and central China from 1991 to 1992 showed that COPD accounted for about 3% of the population over 15 years old. Recent survey results of 20 245 adults in 7 regions of China showed that the prevalence of COPD accounted for 8.2% of the population over 40 years old^[3,4]。 The results of the Latin American Epidemiological Study of Chronic Obstructive Pulmonary Disease (PLATTNO) and the Burden of Chronic Obstructive Pulmonary Disease (BOLD) also indicate that the incidence of COPD is higher than expected, and there are serious missed and misdiagnoses, which greatly affect the prognosis of COPD patients^[5]。 There are many reasons for poor prognosis of COPD, such as difficulty in diagnosis of COPD and no effective method to change the disease course; Early diagnosis may lead to increased costs and misdiagnosis, and may increase the burden of disease due to the lack of effective intervention methods, among other things. Therefore, past and current COPD guidelines and recommendations have focused patient management on smoking cessation, symptom control, and management of end-stage disease. However, recent studies have shown that certain treatments can improve the prognosis of patients with mild to moderate COPD^[6,7]These evidences compelled us to reconsider the past principles of COPD management and recognize that early diagnosis and early intervention of COPD, a chronic disease, should be a key part of disease management.

Since the global outbreak of new type of influenza A (H1N1) in April 2009, this journal organized experts to publish a supplement "Influenza A (H1N1)" in May 2009, which explained the etiology, epidemiology, prevention and treatment of influenza A, and set up a "new type of influenza A (H1N1) column" in this journal in time to exchange information and clinical diagnosis and treatment experience of doctors all over the country in time. This issue focuses on influenza A. Professor Liu Youning, the editor-in-chief of this journal, summarizes our experience and lessons in dealing with SARS, human avian influenza and influenza A since 2003 in the article "Thinking of the Past and the Future-Scientific Response to the Challenge of Respiratory Viral Infectious Diseases", and puts forward that the experience of dealing with respiratory viral infectious diseases, especially influenza A, is worth considering in the future. Lu Li et al. analyzed the antibody level of influenza A virus before vaccination of permanent residents aged 5 and above in Beijing. The results showed that among 3,499 investigators, the positive rate of influenza A virus antibody was 11.06%, and the antibody level of people aged 5~19 was high, which suggested that the immunity of Beijing population had not yet reached the ideal state, and the vaccination work in Beijing should be continuously strengthened to further improve the immunity level of the population. Wang Xiaojie et al. analyzed the clinical characteristics of 55 critical cases of influenza A. Among the 55 cases, 54 cases were complicated by respiratory failure and 26 cases were complicated by ARDS. The results showed that young adults, obese, underlying diseases and pregnant influenza A patients were prone to progression to critical illness, and the mortality rate of patients with high body mass index and secondary fungal infection was high. Di Qingguo et al. studied the clinical manifestations and characteristics of pregnant patients complicated by severe influenza A. Among the 16 severe patients, 15 were pregnant women, 7 patients who had timely cesarean section to terminate their pregnancy or gave birth naturally were in stable condition, and 2 late pregnant women had intrauterine fetal death without death. The results suggest that pregnant women are at high risk of influenza A, and the disease is easy to progress; Early antiviral, early termination of pregnancy, early oxygen therapy and timely mechanical ventilation assisted breathing can improve the prognosis of patients. Luo Hong et al. and Wang Ping et al. analyzed and reported the lung imaging changes of influenza A cases and the characteristics of influenza A group patients respectively. The above research results provide useful experience for the possible reoccurrence of influenza A epidemic in the future.