人感染H7N9病毒的感染源果真是鸡等家禽，其铁板钉钉的证据已经找到了；让人最为关注与担忧的“人传人”悬念也有了端倪：病毒的基因如一部旋转楼梯，如果各个台阶稳定，传染性就不明显。但目前已发现其中3个“台阶”的位置发生了变化，假如再有一个“台阶”移位，就会破坏“楼梯”的稳定性，那么这个病毒就会导致“人传人”了。

Human infection with H7N9 virus, are the source of infection, chicken and other poultry,The iron nail evidence has been found;Let a person's attention and concern"Human-to-human transmission"Has the suspense also:Virus genes, like a spiral staircase,If every step is stable,Infectious is not obvious.But it has been found that three of them"The steps"The location of the changed,If have one"The steps"shift,You will spoil"The stairs"The stability of the,So the virus can cause"Human-to-human transmission"the.

　　“希望第四个台阶发生移位的可怕结果不会出现！我们会密切关注，尽可能地提前预警。”昨日在浙大一院召开的新闻发布会上，李兰娟院士充满信心地说。

"Hope the fourth step is shifted the terrible result will not appear!We will pay close attention to,As far as possible early warning in advance."One held a press conference yesterday in zhejiang university,Li Lanjuan academician said with confidence.

　　从发布会上，记者获悉，李兰娟院士为首的中国科学家在H7N9禽流感研究方面取得了重大突破，论文《人类感染活禽市场来源的新发H7N9亚型禽流感病毒：临床分析和病毒基因组特征》，已在世界著名医学期刊《柳叶刀》在线发表。

From the conference,Reporter has learned that,Li Lanjuan academicians led by Chinese scientists in H7N9 achieved a major breakthrough in the avian influenza research,paper[Human infection source of live poultry markets new H7N9 subtype avian influenza virus:Clinical analysis and viral genome features],Has been the world famous medical journals[The lancet]Published online.

　　该论文对H7N9新病毒的基因，疾病的传染源，以及病毒传播方式等热点问题有了新的解读。给我国H7N9的防控以及国际流感研究都添上了重要一笔。

The paper of H7N9 new virus genes,The main source for the spread of disease,And the way the spread of the virus hot spot problems such as a new interpretation.H7N9 to China on the prevention and control as well as international influenza research of important.

　　

感染源锁定“禽类” The source of infection to lock"poultry"

　　

拿到了基因证据 Got the genetic evidence

　　在《柳叶刀》在线发表的这篇H7N9研究论文中，李兰娟院士是通讯作者，其他作者还包括了浙大一院和香港大学两地国家重点实验室的临床及科研专家，凝聚了团队研究的力量。

In the[The lancet]The papers published in the online H7N9 research paper,Li Lanjuan academician is the corresponding author,Other authors also includes the zhejiang university state key laboratory of a hospital and the university of Hong Kong experts in clinical and scientific research,The power of the team.

　　“长三角”发现H7N9病例以来，一方面政府关闭了活禽市场，许多农贸市场看不到鸡鸭了，市民也不敢吃了；另一方面，近40%的确诊病人却找不到接触过鸡鸭的流行病学史，那么鸡鸭到底是不是H7N9的传染源？这篇文章首次在国际上拿出了证据：H7N9病毒就是从禽类向人类传播的。

"Yangtze river delta"Since found H7N9 cases,On the one hand, the government shut down live-bird markets,Many farmers' markets lost sight of chickens and ducks,Citizens also dare not eat;On the other hand,Nearly 40% of diagnosed patients cannot find epidemiological history of exposure to chickens and ducks,So the source of infection of chickens, ducks are H7N9?This article took out evidence in the world for the first time:H7N9 virus is spread from poultry to humans.

　　李兰娟院士介绍说，我们对患者体内分离出的H7N9病毒，与活禽市场的鸡中分离出的H7N9病毒株进行遗传学比较，研究发现，毒株之间的基因序列非常接近，同源性超过99.4%。

Li Lanjuan member said,We are patient H7N9 isolated the virus,Chickens and live poultry markets H7N9 strains isolated in genetics,Studies have found that,Strains between the gene sequence is very close,Homology of more than 99.4%.

　　

监测人传人 Monitoring of human-to-human transmission

　　

找到有效方法 To find effective methods to

　　H7N9病毒是2011年从韩国的野鸭身上分离发现的。今年3月，它从禽类“跳”到哺乳动物和人身上，那么H7N9病毒会不会在哺乳动物之间来去自由，导致人际间的传播扩散？

H7N9 virus was discovered 2011 ducks separation from South Korea.In march of this year,It from the birds"jump"To mammals and humans,Then H7N9 virus can not freely flowing between mammals,Lead to spread between people?

　　这篇论文是这样回答这个问题的：

This paper is to answer the question:

　　如其他病毒一样，H7N9有它特有的基因序列。如果把H7N9病毒的基因序列比喻成一条长长的楼梯，那么不同的基因和位点，就好像是其中的台阶和其定位。

Like other viruses,H7N9 has its unique genetic sequences.If compared H7N9 virus gene sequences to a long stairs,So many different genes and loci,As one of the steps and its location.

　　此次研究发现了其中4个“台阶”及定位是关键，如果它们突然改变，那么人传人将成事实。研究发现，有个H7基因里的2个氨基酸位点已发生了“移位”，相当于2个台阶位置变了，这意味着病毒与人类呼吸道上皮细胞的亲和力增强了，所以今年春天，H7N9从禽传给人变得轻而易举了。

The study found that the four of them"The steps"And positioning is the key,If they suddenly changed,Human-to-human transmission will be into the truth.Studies have found that,A 2 amino acid sites in the H7 gene had occurred"shift",Equivalent to 2 steps position changed,This means that the virus and the affinity of human airway epithelial cells increased,So this spring,Easy H7N9 from birds to people.

　　但能否人传人，关键还得看另外一个PB2基因，这基因也有2个氨基酸位点。目前，科研团队已发现它们中，1个位点已发生变异，要高度警惕的是，如果这2个氨基酸位点同时发生变异，将使病毒发生有效的人向人传播。

But whether human-to-human transmission,The key also depends on another PB2 gene,This gene also has 2 amino acid sites.At present,Scientific research team has found in them,A locus mutation has occurred,Want to is on high alert,If these two amino acids locus mutation at the same time,Will make the viruses are effectively spread person to person.

　　“这个可能性大吗？”记者问。

"This possibility?"The reporter asked.

　　李兰娟说，以往的H5N1及其他甲流病毒中，这位点没有发生过变异。不过，不等于说它以后在H7N9中也不可能，因此需要密切关注。

Li Lanjuan said,Previous H5N1 and other a/h1n1 flu virus,The site there have been no variations.but,Is not equal to say it later in H7N9 is impossible,So you need to pay close attention to.

　　

H7N9病毒“嗜肺” H7N9 virus"Addicted to the lungs"

　　

原因也找到了 Also found the reasons

　　临床研究还发现，H7N9禽流感感染者的症状与H5N1禽流感大致相似，患者出现高烧和呼吸困难等症状，随后的3~14天内出现呼吸衰竭。

This clinical study also found,H7N9 symptoms of avian influenza infection with the H5N1 avian influenza is roughly similar,Patients with a high fever and breathing difficulties and other symptoms,The following 3 ~ 14 days in respiratory failure.

　　也就是说，H7N9病毒的确“嗜肺”。其原因在研究中有了新的揭示。研究者发现，重症感染患者中普遍存在“细胞因子风暴”现象，这种现象导致了肺被病毒大量侵蚀。找到原因之后，研究者又在临床治疗中，创造性地应用人工肝技术，来清除炎症因子，抑制炎症反应，避免了大规模的“细胞因子风暴”，帮助患者渡过器官功能衰竭难关，从而降低了病死率。记者 王蕊 本报通讯员 王其玲 陈瑜

That is to say,H7N9 virus indeed"Addicted to the lungs".The reason in the study had a new revealed.The researchers found that,Is common in patients with severe infection"Cytokine storm"phenomenon,This phenomenon resulted in the lung of erosion by the virus.After find out why,Researchers in the clinical treatment,Creative artificial liver technology applications,To remove inflammation factors,Inhibit the inflammatory response,Avoid the mass"Cytokine storm",Help patients through organ failure difficulty,So as to reduce the case fatality rate.The reporter Wang Rui our correspondent Wang Jiling Chen

　　

热点追踪 Hot spot tracking

　　

消化道传播，还需证据 Spread of the digestive tract,Still need evidence

　　昨日在发布会上，就H7N9的热点问题，记者采访了李兰娟院士。

Yesterday in the conference,H7N9 hotspot problem,Reporters interviewed Li Lanjuan academicians.

　　问：感染源找到了，病毒的传播途径是否也找到了？

q:The source of infection was found,The spread of the virus way is found?

　　答：传播途径依然在研究当中，目前，呼吸道传播是专家比较一致的观点。我们在观察有没有消化道传播的可能。此前，我们检测过几个大便样本，有轻度阳性，但没有活的病毒，推测可能是呼吸道的病毒通过吞咽进入消化道，但不代表病毒已经通过消化道传播，需要进一步探索研究。

answer:Route of transmission is still in research,At present,Spread respiratory tract is the common viewpoint Shared by experts.We have observed in the spread of the digestive tract.after,We tested several stool samples,Had mild positive,But there is no live virus,Speculation may be respiratory viruses by swallowing into the digestive tract,But do not represent the virus has spread through the digestive tract,Need further research.

　　问：为什么病重的都是年纪大的？

q:Why do sick are older?

　　答：浙大一院救治的患者，60%以上是高龄，高龄是危险因素之一；还有，冠心病、高血压等基础病，也是危险因素；还有经常去活禽市场，接触活禽的人群，也有风险，因为我们收治的70%的患者有禽类接触史。

answer:Zhejiang university hospital treatment of patients,Is more than 60%,Age is one of risk factors;There are,Coronary heart disease/The basis of disease such as high blood pressure,And risk factors;And often go to live poultry market,Contact with live birds,Also has a risk,Because we were in 70% of patients with a history of poultry exposure.

　　问：现在用的抗病毒药，会不会产生耐药？

q:Now with antiviral drugs,Will produce resistance?

　　答：目前，病毒对奥斯他维药物比较敏感，说明是有效的。耐药情况在进一步检测，我们也在研究中药的效果。

answer:At present,Virus is more sensitive to Austin, he d drugs,That is effective.Drug resistance situation in further testing,We are also study the effect of Chinese traditional medicine.

　　问：活禽市场的销售人员，与禽类接触多，但是多数人没有感染，是不是他们有抗体？

q:Live poultry market sales staff,Contact with poultry,But most people do not have the infection,Whether they have antibodies?

　　答：目前，到底有没有隐性感染或者有没有抗体？流行病学调查对密切接触者做了几百例，都是阴性，只能说暂时没有。免疫学方面的检测，下一步要继续研究。

answer:At present,What have the recessive infection or have antibodies?Epidemiological investigation done to close contact with hundreds of cases,Are all negative,Can only say no for the time being.Immunological aspects of detection,The next step to continue studying.

　　问：病毒在人类的下呼吸道聚集，是不是提示咽拭子检测可能不准确？

q:Gathered under the virus in the human respiratory tract,If prompt pharyngeal swab test may not be accurate?

　　答：的确有可能。我们检测了很多患者，上呼吸道的咽拭子病毒检测是阴性，但从下呼吸道的深部痰液检测中测定却是阳性的。这也是病毒的“嗜肺”特性决定的。说明，病毒重点感染患者的下呼吸道。所以只有下呼吸道痰液测试是阴性，才是排除H7N9感染。

answer:There are may.We tested many patients,Upper respiratory tract virus detection of swabs were negative,But from the lower respiratory tract deep sputum test is positive.It's also one of the virus"Addicted to the lungs"Nature of the.instructions,Virus infection were mainly lower respiratory tract.So only the lower respiratory tract sputum test was negative,H7N9 infection is ruled out.

　　问：患者治疗过程中有血清抗体的变化，是否提示有制作疫苗的可能性？

q:Patients with serum antibodies in the process of change,Whether there is the possibility of making vaccines to prompt?

　　答：对，患者血清已产生抗体，这对研究疫苗很有帮助。患者产生的抗体，对自己有一定的保护作用，他们康复后可以避免再次传染这个病，但是要获取他们的抗体，帮助其他没有感染的人产生免疫力，需要多少有抗体的血清我们还在研究，很快会有新的研究成果。记者 王蕊 通讯员 王其玲 陈瑜

answer:for,In patients with serum has to produce antibodies,It is of great help to study the vaccine.Patients produce antibodies,Has certain protective effect to oneself,They can avoid catching the disease again after rehabilitation,But to get their antibodies,Help others without infection immunity,How many have antibodies in serum we are still in the study,Soon there will be a new research results.Reporter Wang Rui correspondent Wang Jiling Chen