39例内脏利什曼病的流行病学和临床特征分析  

Epidemiological and clinical characteristics of 39 cases of visceral leishmaniasis in China

作　　者：吴云 田小军[1,2] 齐志群 李威[1,2] 安亦军 吴赵勇[1,2] 栗绍刚 WU Yun;TIAN Xiao-jun;QI Zhi-qun;LI Wei;AN Yi-jun;WU Zhao-yong;LI Shao-gang(Beijing Tropical Medicine Research Institute,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases)

机构地区：[1]首都医科大学附属北京友谊医院热带医学研究所,北京100050 [2]北京热带病防治研究北京市重点实验室

出　　处：《中国病原生物学杂志》2021年第3期324-327,331,共5页Journal of Pathogen Biology

基　　金：首都医科大学附属北京友谊医院科研启动基金资助项目(No.yyqdkt2019-42)。

摘　　要：目的对首都医科大学附属北京友谊医院收治的内脏利什曼病例进行回顾性研究,为制定有效的诊治内脏利什曼病提供依据。方法对本院收治的39例内脏利什曼病患者的地域分布、人群结构、临床表现、实验室检查、病原学检查、血清抗rk39抗体检测、诊治情况及转归进行统计分析。结果39例内脏利什曼病患者分别为来自山西(29例)、甘肃(6例)、河北(2例)、陕西(1例)和河南(1例)。患者以成人为主(31/39),男女性别比为1.3∶1。临床症状及体征主要表现为发热、乏力、咳嗽、盗汗、呕吐、头痛以及脾、肝脏增大。实验室检查主要为血红蛋白降低、全血细胞减少、红细胞减少、白细胞减少、血小板减少、血清白蛋白减少、血清球蛋白增加、嗜酸性粒细胞降低。常见的合并感染病原体有支原体、细菌性肺炎、萨科奇病毒、衣原体、EB病毒和腺病毒。本组病例抗rK39抗体检测的敏感度为92.31%,骨髓镜检的敏感度为64.1%。使用葡萄糖酸锑钠治疗利什曼原虫多数患者有效(33/34),1例患者怀疑锑剂耐药(1/34),及时治疗多数患者预后良好。结论内脏利什曼病患者地区分布不均匀,居住以农村为主,易误诊,应提高该病的诊断能力,以降低病死率,为内脏利什曼病的诊断及治疗提供参考依据。Objective To retrospectively study visceral leishmaniasis(VL)at this Hospital in order to provide a reference for diagnosis and treatment of VL.Methods The regional distribution,population composition,clinical manifestations,laboratory results,etiology,anti-rk39 antibody test results,treatment of,and prognosis for 39 patients with VL were analyzed.Results Patients with VL seen at this Hospital were from Shanxi(n=29),Gansu(n=6),Hebei(n=2),Shanxi(n=1),and Henan(n=1).Most patients were adults(31/39),with a sex ratio of 1.3:1.The main clinical symptoms were a fever,fatigue,coughing,night sweats,vomiting,headaches,and enlargement of the spleen and liver.Laboratory indices were as follows:hemoglobin,pancytopenia,erythrocytopenia,leukopenia,thrombocytopenia,and serum albumin decreased,serum globulin increased,and eosinophil decreased.Common pathogens co-infecting patients with VL were mycoplasma,bacterial pneumonia,Sarkozy virus,chlamydia,the EB virus,and adenoviruses.In patients with VL,anti-rK39 antibody detection had a sensitivity of 92.31%,and bone marrow microscopy had a sensitivity of 64.1%.Sodium antimony gluconate was effective in the treatment of leishmaniasis in most patients(33/34),and one patient was suspected of having antimony resistance(1/34).Most of the patients had a favorable prognosis after timely treatment.Conclusion Patients with VL mainly live in rural areas and are easily misdiagnosed.Thus,the ability of physicians to diagnose the disease should be improved to reduce its mortality rate.These findings should provide a reference for clinical diagnosis and treatment of patients with VL.

关 键 词：内脏利什曼病 嗜酸性粒细胞 利什曼原虫 临床流行病学 

分 类 号：R531.6[医药卫生—内科学]