发热伴血小板减少综合征并发脑室出血及侵袭性肺曲霉菌病一例临床分析  

Clinical analysis of a case with severe fever and thrombocytopenia syndrome complicated with spontaneous intraventricular hemorrhage and invasive pulmonary aspergillosis

作　　者：尚振德[1] 孙密密 孙即奎[1] 孟宪兵[1] 武涛[1] 姬广福[1] 

机构地区：[1]泰山医学院附属医院神经外科,泰安市271000 [2]解放军第88医院全军肝病诊治中心,泰安市271000

出　　处：《中华实验和临床感染病杂志（电子版）》2017年第1期101-104,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的提高对发热伴血小板减少综合征并发自发性脑室出血、侵袭性肺部曲霉菌病的临床特点的认知。方法结合1例发热伴血小板减少综合征并发脑室出血及侵袭性肺部曲霉菌感染者的临床资料及文献复习,对本病的临床表现、实验室指标、影像学特征、诊断及治疗加以分析。结果发热伴血小板减少综合征以白细胞及血小板减少为主要特点,以发热、乏力、咳嗽、咯痰为主要临床表现,可引起心、肝、肾、凝血等多脏器损害,重者病死率高;脑室出血可因凝血功能异常导致,及时恰当的救治预后较好;侵袭性肺曲霉菌病在难以取得活检组织病理结果的情况下,应结合宿主因素、肺部感染的临床特征、生物学指标及时做出临床诊断,尽早治疗可降低病死率。结论发热伴血小板减少综合征合并脑室出血及侵袭性肺曲霉菌感染的病例临床罕见,其发生可能与白细胞及血小板减少、免疫力低下、凝血异常有关。Objective To improve the understanding of the clinical features of severe fever with thrombocytopenia syndrome （SFTS） incorporative spontaneous intraventricular hemorrhage and invasive pulmonary aspergillosis （IPA）. Methods The clinical manifestations, laboratory tests, radiographic, diagnosis and treatment of the case suferring from SFTS complicated with spontaneous intraventricular hemorrhage and IPA were analyzed through the literature review. Results The prominent feature of SFTS was leukocytopenia and thrombocytopenia. Fever, malaise, cough and expectoration were the main clinical manifestations of SFTS. Damage of multiple-organ （such as liver, kidney, heart and coagulation） may occure. Spontaneous intraventrieular hemorrhage was caused by dysfunction of blood coagulation. As it was hard to get the pathological data of lung, IPA should be diagnosed through risk factors, clinical symptoms of pulmonary infection, biological indicator so as to start empirical antifimgal treatment as early as possible and reduce the mortality. Conclusions The occurrence of SFTS complicated with spontaneous intraventricular hemorrhage and IPA is rare in clinic. It may be related to leukocytopenia, thrombocytopenia, hypoimmunity and coagulopathy.

关 键 词：发热伴血小板减少综合征 脑室出血 侵袭性肺曲霉菌病 

分 类 号：R510[医药卫生—内科学] R743.34[医药卫生—临床医学] R519