恙虫病46例临床分析  

Clinical analysis of 46 cases of tsutsugamushi disease

作　　者：吴永城 郑伟江 

机构地区：[1]汕头市濠江区人民医院,广东汕头515071

出　　处：《热带医学杂志》2013年第8期994-995,998,共3页Journal of Tropical Medicine

摘　　要：目的分析汕头市恙虫病的临床特点,减少恙虫病的误诊、误治率。方法对1998-2012年收治的46例恙虫病患者的临床特点及诊治过程进行回顾性分析。结果男女发病率差异无统计学意义;青壮年发病率较高;全部病例均有发热、头痛、全身酸痛、焦痂或溃疡等表现;淋巴结肿大25例(54.3%),脾大9例(19.5%),肝大2例(4.3%),心率失常11例(26%),皮疹2例(4.3%),外斐反应阳性13例(28.2%),外周血白细胞正常36例(78.3%)、白细胞增高7例(15%)、白细胞减少3例(6.5%),中性粒细胞升高33例(71.7),尿液常规蛋白尿5例(11%),血尿3例(6.5%);血生化LDH、ALT、AST、HBDH升高,钠、钾、氯降低较常见。X线检查支气管炎9例(19.5%),肺部感染7例(15.2%)。结论恙虫病在汕头市有散发流行;恙虫病误诊率较高,重视病史采集、认真仔细体检、掌握其特征性,可提高恙虫病的诊断率。Objective To analyze the clinical features of sutsugamushi disease,that may reduce the rate of misdiagnosis and mistreatment.Method Clinical data of 46 cases of tsutsugamushi disease from 1998-2012 in patients with clinical features and treatment were retrospectively analyzed.Results The prevalence had no significant difference in gender.Morbidity in young adults was high.All patients had fever,headache,sore orulcer and eschar,showing enlargement of lymph nodes in 25 cases （54.3%）,splenomegaly in 9 cases （19.5%）,liver enlargement in 2 cases（4.3%）,arrhythmia in 11 cases（26.0%）,skin rash in 2 cases （4.3%）,positive reaction in 13 cases （28.2%）,peripheral blood leukocytes normal in 36 cases （78.3%）,white blood cells increased in 7 cases （15.0%）,white blood cells reduced in 3 patients （6.5%）,neutrophils increased in 33 cases （71.7%）,urine albuminuria in 5 cases （11.0%）,hematuria in 3 cases （6.5%）,and commonly with blood biochemical LDH,ALT,AST and HBDH increased and sodium,potassium,and chloride decrease.X ray examination of bronchiolitis：a report of 9 cases （19.5%）,7 cases of pulmonary infection （15.2%）.Conclusions Tsutsugamushi disease in the Shantou area was sporadically occurring in recent years.The misdiagnosis rate was high.As long as pay attention to medical history collection and physical examination,we can improve the diagnosis rate of tsutsugamushi disease,reduce misdiagnosis and missed diagnosis.

关 键 词：恙虫病 焦痂或溃疡 外斐氏反应 

分 类 号：R532.9[医药卫生—内科学]