儿童恙虫病175例的临床特征及重症恙虫病危险因素  

Clinical Features and Risk Factors for Critical Cases of Scrub Typhus in 175 Children

作　　者：路伟民 杨小涛[2] 朱瑛 黄艺 陈后余 金海凤 王艳春[2] LU Weimin;YANG Xiaotao;ZHU Ying;HUANG Yi;CHEN Houyu;JIN Haifeng;WANG Yanchun(School of Clinical Medicine,Dali University,Dali Yunnan 671000;The 2nd department of Infectious Disease,Kunming Children’s Hospital,Kunming Yunnan 650034,China)

机构地区：[1]大理大学临床医学院,云南大理671000 [2]昆明市儿童医院感染二科,云南昆明650034

出　　处：《昆明医科大学学报》2022年第8期72-80,共9页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(202101AY070001-217);昆明市卫健委“十百千”工程资金资助项目[2020-SW(省)-21]。

摘　　要：目的分析儿童恙虫病临床表现,探讨儿童恙虫病的临床特点及可能进展为重症病例危险因素,为临床医生尽早明确诊断及识别重症患者提供依据。方法回顾性分析昆明市儿童医院2017年至2021年确诊的恙虫病患者病例资料,将纳入对象分为非重症组与重症组,对比各组病例症状、体征、实验室数据、治疗及转归等;将单因素分析中差异有统计学意义的指标纳入多因素Logistic回归分析,对回归分析中有意义的指标绘制识别重症病例的受试者工作特征曲线(ROC)。结果纳入175例病例,非重症组145例(82.9%),重症30例(17.1%);173例好转/治愈,2例死亡。患儿均有发热(100%),体征上焦痂或溃疡占比最高(85.7%),其次为肝脏肿大、淋巴结肿大;与非重症组相比,重症组咳嗽、水肿、肝脏肿大发生率较高,差异有统计学意义(P均<0.05);实验室数据发现纳入病例中嗜酸性粒细胞计数(EOS)和血小板(PLT)减少,谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)、C反应蛋白(CRP)、降钙素原(PCT)升高;重症组与非重症组比较,PLT、EOS、白蛋白(ALB)、纤维蛋白原(FIB)降低(P均<0.05),ALT、AST、LDH、CRP、PCT升高(P均<0.05),凝血酶原时间(PT)、部分凝血酶原时间(APTT)延长(P均<0.05)。多因素Logistic回归分析显示PLT减少(OR:0.980,95%CI 0.966~0.994,P<0.05)、LDH升高(OR:1.002,95%CI 1.000~1.004,P<0.05)是恙虫病发展成重症病例的危险因素。PLT、LDH可用于鉴别诊断重症恙虫病,两者联合诊断灵敏度为89.7%,特异度为76.6%。结论在恙虫病流行季节,发热伴或不伴焦痂或溃疡、有肝脏及淋巴结肿大,实验室指标有嗜酸性粒细胞减少、血小板减少、谷丙转氨酶、谷草转氨酶、乳酸脱氢酶升高有助于诊断恙虫病。血小板减少、乳酸脱氢酶升高是儿童重症恙虫病患者的危险因素。PLT<55.5×10^(9)/L、LDH>692U/L早期识别儿童重症恙虫病具有一定诊断价值。Objective To analyze the clinical manifestations of scrub typhus in children,and the risk factors that may progress to critical cases were discussed,so as to provide a basis for clinicians to diagnose and identify critical patients as soon as possible.Methods The data of scrub typhus patients diagnosed in Kunming Children’s Hospital from 2017 to 2021 were retrospectively analyzed.The subjects were divided into non-critical group and critical group,and the symptoms,signs,laboratory data,treatment and outcome of each group were compared.The indexes with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis,and the receiver operating characteristic curve(ROC)for identifying severe cases was drawn for the indexes that were significant in regression analysis.Results Among the enrolled 175 cases,145 cases(82.9%)were in the non-critical group and 30 cases(17.1%)in the critical group.There was 2 patients died and other 173 patients were improved or cured after treatment.All the children had fever(100%),eschar or ulcer were common(85.7%),followed by hepatomegaly and lymphadenopathy.Compared with the non-severe group,the incidence of cough,edema and hepatomegaly was higher in critical group,and the differences were statistically significant(P<0.05).Laboratory tests of all enrolled cases demonstrated that the levels of eosinophils(EOS),platelet counts(PLT)and albumin(ALB)significantly decreased,and the levels of alanine transaminase(ALT),aspertate aminotransferase(AST),lactate dehydrogenase(LDH),C reactive protein(CRP),procalcitonin(PCT)increased.Compared with non-critical group,PLT,EOS,ALB and FIBRinogen(FIB)in critical group were decreased(ALL P<0.05),ALT,AST,LDH,CRP and PCT in critical group were increased(P<0.05),prothrombin time(PT)and partial prothrombin time(APTT)were prolonged(P<0.05).Multivariate logistic regression analysis showed that PLT(OR:0.980,95%CI 0.966~0.994,P<0.05)and LDH(OR:1.002,95%CI 1.000~1.004,P<0.05)were risk factors for scrub typhu

关 键 词：儿童恙虫病 临床特征 重症恙虫病 诊断 危险因素 

分 类 号：R725.1[医药卫生—儿科]