恙虫病的临床特征及重症恙虫病的早期诊断  

Clinical features of scrub typhus and early diagnosis of severe scrub typhus

作　　者：王瑞丽[1] 戴威[2] 程碧环[1] 陈永平[3] 龚裕强[1] WANG Ruili;DAI Wei;CHENG Bihuan;CHEN Yongping;GONG Yuqiang(Department of Critical Care, the Second Affiliated Hos- pital ＆ Yuying Children＇s Hospital of Wenzhou Medical University, Wenzhou, 325027;Department of Genetal Mdeieine, the Second Affiliated Hospital ＆ Yuying Children＇s Hospital of Wenzhou Medical University, Wenzhou, 325027;Department of lnfectious Diseases, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015)

机构地区：[1]温州医科大学附属第二医院育英儿童医院重症医学科,浙江温州325027 [2]温州医科大学附属第二医院育英儿童医院全科医学科,浙江温州325027 [3]温州医科大学附属第一医院感染内科,浙江温州325015

出　　处：《温州医科大学学报》2017年第11期832-835,共4页Journal of Wenzhou Medical University

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。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 clini- cal data of 81 cases of scrub typhus which came from the First Affiliated Hospitals of Wenzhou Medical Univer- sity 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=l.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 use- ful for the diagnosis of scrub typhus. Increased white blood cells and decreased platelets are the risk indicators related to severe scrub typhus.

关 键 词：重症恙虫病 危险因素 早期诊断 

分 类 号：R51[医药卫生—内科学]