51例儿童恙虫病的临床分析  

Clinical analysis of 51 children with tsutsugamushi disease

作　　者：杨雅婷 欧远贵 邓燕艺 马晓红[1] 韦并阳 YANG Yating;OU Yuangui;DENG Yanyi;MA Xiaohong;WEI Bingyang(Pediatrics Department,Red Cross Hospital of Yulin City,Yulin 537000,China)

机构地区：[1]玉林市红十字会医院儿科,广西玉林537000

出　　处：《临床医学研究与实践》2021年第9期12-14,共3页Clinical Research and Practice

摘　　要：目的分析儿童恙虫病的临床特点,为临床诊断及治疗提供依据。方法回顾性分析2015年1月至2020年1月我院收治的51例恙虫病患儿的临床资料,并分析其临床特点、辅助检查结果及治疗和转归情况。结果51例患儿中,男28例,女23例,年龄11个月至14岁,临床表现主要有发热51例(100.0%)、咳嗽17例(33.3%)、焦痂或溃疡37例(72.5%)、淋巴结肿大22例(43.1%)、肝脾肿大13例(25.5%);白细胞升高34例(66.7%),嗜酸性粒细胞降低38例(74.5%),血小板降低14例(27.5%);肝功能异常37例(72.5%),凝血功能显著异常8例(15.7%),外斐试验阳性4例(7.8%),肺部影像学异常18例(35.3%);诊断延误17例(33.3%),重症8例(15.7%),死亡1例(2.0%)。结论儿童恙虫病临床表现缺乏特异性,误诊率高,不及时诊治易发展为重症;皮肤溃疡或焦痂、嗜酸性粒细胞计数明显降低可协助早期诊断,及时使用阿奇霉素或多西环素治疗是改善预后的关键。Objective To analyze the clinical characteristics of tsutsugamushi disease in children and to provide evidence for clinical diagnosis and treatment.Methods The clinical data of 51 children with tsutsugamushi disease admitted in our hospital from January 2015 to January 2020 were retrospectively analyzed,and their clinical characteristics,auxiliary examination results,treatment and outcome were analyzed.Results Among the 51 cases,there were 28 males and 23 females,aged from 11 months to 14 years.The main clinical manifestations were fever in 51 cases(100.0%),cough in 17 cases(33.3%),eschar or ulcer in 37 cases(72.5%),lymphadenopathy in 22 cases(43.1%),hepatosplenomegaly in 13 cases(25.5%);34 cases(66.7%)had elevated leukocyte,38 cases(74.5%)had decreased eosinophil and 14 cases(27.5%)had decreased platelet;there were 37 cases(72.5%)with abnormal liver function,8 cases(15.7%)with significantly abnormal coagulation function,4 cases(7.8%)with positive Weil-Felix test,and 18 cases(35.3%)with abnormal pulmonary imaging;there were 17 cases(33.3%)of delayed diagnosis,8 cases(15.7%)of severe disease,and 1 case(2.0%)of death.Conclusion The clinical manifestations of childhood tsutsugamushi disease are lack of specificity,and the rate of clinical misdiagnosis is high.Without timely diagnosis and treatment,it is easy to develop into severe disease.Skin ulcer,eschar and decreased eosinophil count may aid in early diagnosis.The key to improve the prognosis is to use azithromycin or doxycycline in time.

关 键 词：恙虫病 儿童 临床特征 

分 类 号：R513.2[医药卫生—内科学]