恙虫病的临床特征及重症恙虫病的早期诊断

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1424 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：分析恙虫病的临床特征，探讨重症恙虫病发生的危险因素，为临床早期诊断重症恙虫病提供参考。方法：对2010年1月至2016年8月温州医科大学附属第一医院和温州医科大学附属第二医院育英儿童医院住院的81例恙虫病患者的临床资料进行回顾性分析，总结其临床特征；依据是否入住ICU将患者分为曾入住ICU组（重症恙虫病组）与未入住ICU组（非重症恙虫病组），logistic回归分析2组患者的临床特征、实验室检查，探讨与重症恙虫病发生相关的临床指标。结果：恙虫病患者均存在不同程度的发热，临床症状多样而缺乏特异性，体征方面87.7%的患者出现焦痂或溃疡，实验室检查易发现嗜酸粒细胞比例或计数降低及谷丙、谷草转氨酶不同程度升高（均高于70%）；logistic回归分析发现与重症恙虫病发病相关的指标为白细胞计数升高（OR=1.401）、血小板计数降低（OR=0.087）。结论：发热患者体格检查发现焦痂或溃疡，实验室检查提示嗜酸性粒细胞比例或计数降低，谷丙、谷草转氨酶浓度升高有助于恙虫病的诊断；白细胞计数增高、血小板计数降低为重症恙虫病的危险因素。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	王瑞丽
	戴威
	程碧环
	陈永平
	龚裕强

关键词 ：重症恙虫病, 危险因素, 早期诊断

Abstract：Objective: To explore the clinical characteristics of scrub typhus and analyze the risk factors of severe scrub typhus, which can provide reference for early diagnosis of severe scrub typhus. Methods: The clinical data of 81 cases of scrub typhus which came from the First Affiliated Hospitals of Wenzhou Medical University and the Second Affiliated Hospitals & Yuying Children’s Hospital of Wenzhou Medical University between January 2010 and August 2016 were retrospectively analyzed, then summarized the clinical characteristics of these patients. According to whether to stay in the ICU, all patients were dividived into two groups: severe scrub typhus group and non-severe scrub typhus group. Logistic regression was used to analyze the clinical features and laboratory tests of two groups, which can be used to identify factors associated with severe scrub typhus. Results: All patients showed different degree of fever and clinical symptoms of scrub typhus were various but lack of specificity; eighty-seven percent of the patients had eschar or ulcer; the reduction of eosinophil percentage and (or) count, elevation of alanine transaminase and aspertate aminotransferase laboratory tests were easeily to find. Logistic regression analysis found that there were significant differences, such as elevated white blood cell count (OR=1.401) and decreased platelet count (OR=0.087) between severe scrub typhus group and non-severe scrub typhus group. Conclusion: Eschar or ulcer was found in medical examination, the decreased of eosinophil percentage or count and increased of liver transaminase were found in laboratory tests in fever pantients are useful for the diagnosis of scrub typhus. Increased white blood cells and decreased platelets are the risk indicators related to severe scrub typhus.

Key words： severe scrub typhus risk factors early diagnosis

收稿日期: 2017-01-29

通讯作者: 龚裕强，主任医师，硕士生导师，Email：gyq192063@163.com

作者简介: 王瑞丽（1987-），女，山西长治人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2017/V47/I11/836

[1] KIM D M, KIM S W, CHOI S H, et al. Clinical and laboratory findings associated with severe scrub typhus[J]. BMC Infect Dis, 2010, 10: 108.
[2] WATT G, PAROLA P. Scrub typhus and tropical rickettsioses J]. Curr Opin Infect Dis, 2003, 16(5): 429-436.
[3] 张鲁燕, 毕振旺, 赵仲堂. 我国恙虫病东方体分子流行病学研究进展[J]. 中华流行病学杂志, 2014, 35(1): 88-92.
[4] 孙明, 汪东亮, 赵春云, 等. 宿迁地区32例恙虫病临床特征分析[J]. 中国血吸虫病防治杂志, 2013, 25(6): 639-641.
[5] 廖云珍, 叶晓光, 罗润齐. 恙虫病误诊原因分析[J]. 广东医学, 2010, 31(4): 488-490.
[6] 杨松, 张耀亭, 邱跃灵. 58例恙虫病并发肺部感染的流行病学及临床分析[J]. 临床肺科杂志, 2016, 21(8): 1439-1442.
[7] SUBBALAXMI M V, MADISETTY M K, PRASAD A K, et al. Outbreak of scrub typhus in Andhra Pradesh— experience at a tertiary care hospital[J]. J Assoc Physicians India, 2014, 62(6): 490-496.
[8] 张彦, 张学武, 胡国启, 等. 以嗜酸粒细胞减少为主要特征
的117例恙虫病报告[J]. 中华传染病杂志, 2014, 32(6): 330-333.
[9] VENKATEGOWDA P M, RAO S M, MUTKULE D P, et al. Scrub typhus: Clinical spectrum and outcome[J]. Indian J Crit Care Med, 2015, 19(4): 208-213.
[10] CHRISPAL A, BOORUGU H, GOPINATH K G, et al. Scrub
typhus: an unrecognized threat in South India-clinical profile and predictors of mortality[J]. Trop Doct, 2010, 40(3): 129-133.
[11] SRIWONGPAN P, KRITTIGAMAS P, KANTIPONG P, et al. Clinical indicators for severe prognosis of scrub typhus[J]. Risk Manag Healthc Policy, 2013, 6: 43-49.
[12] ZHANG L, ZHAO Z, BI Z, et al. Risk factors associated with severe scrub typhus in Shandong, northern China[J]. Int J Infect Dis, 2014, 29: 203-207.
[13] SRIWONGPAN P, KRITTIGAMAS P, TANTIPONG H, et al. Clinical risk-scoring algorithm to forecast scrub typhus se-verity[J]. Risk Manag Healthc Policy, 2013, 7: 11-17.
[14] 薛聃, 魏琼英, 林琼. 恙虫病患者血清降钙素原水平的变化及其临床意义[J]. 中华传染病杂志, 2015, 33(3): 166-167.
[15] DUONG V, MAI T T, BLASDELL K, et al. Molecular epidemiology of Orientia tsutsugamushi in Cambodia and Central Vietnam reveals a broad region-wide genetic diver-sity[J]. Infect Genet Evol, 2013, 15: 35-42.