2016-2021年广东省155例恙虫病患者流行病学和临床表现特征分析  

Epidemiological and clinical characteristics of 155 patients with tsutsugamushi disease in Guangdong Province from 2016 to 2021

作　　者：梁桐 刘莹[1] 李幼霞 蔡水江 黄煌 刘勇进 杜淑华 赖文娇 邓西龙 Liang Tong;Liu Ying;Li Youxia;Cai Shuijiang;Huang Huang;Liu Yongjin;Du Shuhua;Lai Wenjiao;Deng Xilong(Department of Critical Care Medicine,the Eighth Hospital Affiliated to Guangzhou Medical University,Guangzhou 510080,China)

机构地区：[1]广州医科大学附属市八医院重症医学科,广州510080

出　　处：《中华地方病学杂志》2023年第10期827-832,共6页Chinese Journal of Endemiology

基　　金：广东省科学技术厅重点项目(2021A1111110001)

摘　　要：目的分析广东省恙虫病患者流行病学和临床表现特征,为恙虫病临床诊疗和科学防控提供参考依据。方法采用回顾性分析,收集2016-2021年广州医科大学附属市八医院收治的恙虫病患者信息,包括患者基本情况、流行病学特征、临床表现、辅助检查结果、并发症、首诊误诊情况及治疗转归等内容。结果共收集恙虫病患者155例,其中男性75例(48.39%),女性80例(51.61%),年龄为(54.41±13.78)岁。每年6至9月发病人数较多。155名患者中有30人(19.35%)存在其他基础疾病。广州市本地患者97人(62.58%),其他地级市患者58人(37.42%)。发病前有野外活动史患者占76.77%(119/155)。全部患者中,农民为主要发病人群,占36.13%(56/155)。常见临床表现为发热(100.00%,155/155)、畏寒和/或寒战(77.42%,120/155)、头痛和/或头晕(74.19%,115/155)、疲乏(65.81%,102/155)、焦痂或溃疡(92.90%,144/155)、淋巴结肿大(49.68%,77/155)。实验室检测结果主要表现为嗜酸性粒细胞减少(81.94%,127/155)、血细胞比容降低(78.71%,122/155)、血红蛋白下降(52.26%,81/155)、血小板计数减少(50.97%,79/155),白蛋白降低(92.26%,143/155)、乳酸脱氢酶升高(90.32%,140/155)、腺苷脱氨酶升高(88.39%,137/155)、丙氨酸氨基转移酶升高(85.16%,132/155)、天冬氨酸氨基转移酶升高(85.16%,132/155),降钙素原升高(52.90%,82/155);外斐反应阳性30例(19.35%)。胸部影像学检查结果异常95例(61.29%),腹部B超或CT检查结果异常34例(21.94%)。常见并发症为中毒性肝炎、肺部感染、器官功能衰竭、急性肾损伤等。首诊误诊率为75.48%(117/155)。给予多西环素及对症支持治疗,治愈或好转出院154例(99.35%)。结论广东省恙虫病发病高峰为夏秋季节,发病前大多数患者有野外活动史,农民为易感人群。恙虫病临床表现多样,可累及多系统、多器官,并发症多。使用多西环素进行抗感染治疗,治愈率较高。Objective To analyze the epidemiological and clinical characteristics of patients with tsutsugamushi disease in Guangdong Province from 2016 to 2021,and to provide a reference for clinical diagnosis,treatment,scientific prevention and control of tsutsugamushi disease.Methods A retrospective analysis was conducted to collect the information of patients with tsutsugamushi disease admitted to Guangzhou Eighth Hospital Affiliated to Guangzhou Medical University from 2016 to 2021,including the basic information,epidemiological characteristics,clinical manifestations,auxiliary examinations,complications,misdiagnosis at first diagnosis and treatment outcomes.Results Among 155 patients with tsutsugamushi disease,there were 75 males(48.39%)and 80 females(51.61%),with an e age of(54.41±13.78)years old,and 30 cases(19.35%)had other underlying diseases.The peak time of onset was from June to September.There were 97 local patients(62.58%)in Guangzhou,and 58 cases(37.42%)in other prefecture-level cities;76.77%(119/155)had a history of field activities before the onset of the disease.36.13%(56/155)were farmers.The most common clinical manifestations were fever(100.00%,155/155),chills and/or shivering(77.42%,120/155),headache and/or dizziness(74.19%,115/155),fatigue(65.81%,102/155),eschar or ulcer(92.90%,144/155),and lymphadenopathy(49.68%,77/155).The laboratory test results mainly showed a decrease in eosinophils(81.94%,127/155),a decrease in hematocrit(78.71%,122/155),a decrease in hemoglobin(52.26%,81/155),a decrease in platelet count(50.97%,79/155),a decrease in albumin(92.26%,143/155),an increase in lactate dehydrogenase(90.32%,140/155),an increase in adenosine deaminase(88.39%,137/155),and an increase in alanine aminotransferase(85.16%,132/155),elevated aspartate aminotransferase(85.16%,132/155),and elevated procalcitonin(52.90%,82/155);30 cases(19.35%)were positive for the Weil-Felix Test.There were 95 cases(61.29%)with abnormal chest imaging results,and 34 cases(21.94%)with abnormal abdominal ultrasound or CT results.Co

关 键 词：恙虫病 流行病学 临床特征 宏基因组二代测序 

分 类 号：R513.2[医药卫生—内科学] R181.3[医药卫生—临床医学]