广东省中山地区恙虫病临床与流行病学特征及防治  

Clinico-epidemiologic characteristics,prevention and treatment of scrub typhus in Zhongshan area of Guangdong

作　　者：郑伟华[1,2] 陈海斌[1,2] 侯六生[1,2] 区利娟[1,2] 赵润梅[1,2] 赵双彪[1,2] 

机构地区：[1]中山大学附属中山医院 [2]中山市人民医院急诊科,广东中山528403

出　　处：《临床荟萃》2015年第5期552-555,共4页Clinical Focus

基　　金：广东省中山市科技计划项目(20132A130)

摘　　要：目的：探讨广东省中山地区临床诊断为恙虫病患者的临床和流行病学特征，为早期诊断及防治提供依据。方法对198例恙虫病从流行病学、主要临床表现、实验室及影像学检查、治疗等方面进行分析。结果中山地区恙虫病发病例数逐年上升，发病时间主要集中在5~10月份（91.4%），发病年龄以40~70岁年龄段最多（66.7%），职业构成以农民居多（31.8%），大多数（92.9%）患者有草地等野外活动史，常见表现为发热（100%），焦痂或溃疡（93.9%），实验室检查变形杆菌外斐凝集反应均阴性（100%），多数患者出现肝功能损害为丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、腺苷脱氨酶（ADA）、乳酸脱氢酶（LDH）升高（95%以上）及白蛋白（ALB）减少（80.3%），显示肾损害尿蛋白和尿红细胞（53.0%），炎症反应指标降钙素原（PCT）升高（81.6%）以及嗜酸性粒细胞（EO）计数为0占62.1%，胸部 X 光片提示肺损害的肺部渗出性病变或肺膜炎改变（51.0%），合并两个或以上器官损害达85.4%，多器官功能障碍综合征（MODS）为8.6%。首诊确诊率为68.2%，病死率1.5%。结论恙虫病临床表现复杂多样，常合并多器官损害，并发症多，容易误诊，因此提高认识，早期诊治和加强高危人群健康教育，有利于改善预后和预防控制恙虫病的发生及流行。Objective To explore the clinical and epidemiologic characteristics of scrub typhus in Zhongshan area for evidence for early diagnosis and treatment.Methods A total of 1 98 patients with scrub typhus were analyzed from various aspects, including epidemiologic characteristics, clinical manifestations, labaratory and imageology examinations,and therapeutics.Results The incidence of scrub typhus was increasing year by year and the disease occurred frequently between May and Octorber （91.4%）.Majority of patients were farmers （31.8%）and their main onset age ranged from 40 to 70 years old （66.7%）.Most of patients had history of contacting grassland （92.9%） showing symptoms of fever （100%）,eschar or ulcer （93.9%）.The OXk antigen agglutination reaction of bacillus proteus was negative in all cases.In laboratory examination,the levels of ALT,AST,ADA and LDH were increasing （〉95%）,however,the level of ALB was reducing （80.3% ）;the levels of PCT （81.6% ）,urine protein and erythrocyte （53.0%）were increasing;the level of EO count 0 accounted for 62.1%.Change in pulmonary damage accounted for 5 1.0% by chest X ray.Scrub typhus patients with two or more organ damage accounted for 85.4%,and scrub typhus patients with MODS accounted for 8.6%.The first diagnosis rate was 68.2% and the mortality rate 1.5%.Conclusion The clinical characteristics of scrub typhus are complex,often accmopanied with multiple organ damage and complications,so the disease is likely misdiagnosed.It is important to early diagnose,treat and strengthen health education for high risk population, it is beneficial to improve prognosis and prevent the occurrence and epidemicity of scrub typhus.

关 键 词：丛林斑疹伤寒 体征和症状 流行病学 

分 类 号：R513.2[医药卫生—内科学]