儿童内脏利什曼病41例的流行病学与临床特征分析  

Epidemiological characteristics and clinical features of visceral leishmaniasis in 41 children

作　　者：卫慧静 刘小乖[1] 高晓鹏[2] 李瑞娜[1] 舒畅 雷玲侠[1] Wei Huijing;Liu Xiaoguai;Gao Xiaopeng;Li Ruina;Shu Chang;Lei Lingxia(The Third Department of Children′s Infectious Diseases,Xi′an Children′s Hospital,Xi′an 710003,China;Central Laboratory,Xi′an Children′s Hospital,Xi′an 710003,China)

机构地区：[1]西安市儿童医院感染三科,西安710003 [2]西安市儿童医院中心实验室,西安710003

出　　处：《中华传染病杂志》2022年第8期490-495,共6页Chinese Journal of Infectious Diseases

摘　　要：目的探讨内脏利什曼病(visceral leishmaniasis,VL)儿童的流行病学及临床特点,分析合并噬血细胞性淋巴组织细胞增生症(hemophagocytic lymphohistiocytosis,HLH)的特征,为该病诊治提供参考依据。方法回顾性分析2012年7月至2021年6月西安市儿童医院收治的41例VL患儿的流行病学、临床表现、实验室检查结果、诊治及转归情况,根据患儿是否合并HLH分为单纯VL组和VL+HLH组,对比两组患儿的临床表现与实验室检查指标。统计学分析采用独立样本t检验,曼-惠特尼U检验和χ^(2)检验。结果41例VL患儿分别来自陕西省[70.73%(29/41)]、甘肃省[14.63%(6/41)]、山西省[12.20%(5/41)]和宁夏回族自治区[2.44%(1/41)],农村患儿占87.80%(36/41),高发年龄为>1.0~3.0岁[63.41%(26/41)],全年散发。临床表现和体征有发热[97.56%(40/41)]、脾大[95.12%(39/41)]、淋巴结肿大[82.93%(34/41)]和肝大[60.98%(25/41)]等。经1次、2次和3次骨髓涂片发现利-杜小体者分别为36例、4例和1例。血常规显示贫血、血小板计数和白细胞计数减少者分别占100.00%(41/41)、78.05%(32/41)和58.54%(24/41)。单纯VL组(28例)与VL+HLH组(13例)的血小板计数、乳酸脱氢酶、丙氨酸转氨酶、三酰甘油、纤维蛋白原、铁蛋白差异均有统计学意义(t=-2.56,t=2.64,Z=-2.66,t=7.15,t=-5.76,t=3.86,均P<0.050),单纯VL组肝大比例和骨髓涂片发现噬血细胞比例均低于VL+HLH组,差异均有统计学意义(χ^(2)=4.47、10.93,均P<0.050)。12例VL+HLH患儿使用锑剂6 d方案+静脉输注免疫球蛋白治疗,余均采用锑剂6 d方案,锑剂1个和2个疗程治愈率分别为92.68%(38/41)和4.88%(2/41),1例在1个疗程基础上将锑剂加量1/3并延长治疗至8 d后治愈。随访时间为(41.36±31.49)个月,3例患儿治愈后5~8个月复发,再用锑剂治疗1个疗程后均治愈。结论VL患儿以农村为主,临床常见发热及网状内皮细胞系统受累等相关非特异性表现。骨髓涂片发现利-杜小体阳性�Objective To investigate the epidemiological and clinical characteristics of visceral leishmaniasis(VL)in children,and to analyze the distinguishing features of VL associated hemophagocytic lymphohistiocytosis(HLH),so that to provide reference for the diagnosis and treatment of VL.Methods Forty-one children with VL admitted to Xi′an Children′s Hospital from July 2012 to June 2021 were enrolled.The clinical data were retrospectively analyzed,including epidemiology,clinical manifestations,laboratory data,diagnostic methods,treatment regimens and outcomes.The patients were divided into VL group and VL+HLH group according to whether combined with HLH or not,and the clinical characteristics and laboratory findings of the two groups were compared.Two independent samples t test,Mann-Whitney U test and chi-square test were used for statistical analysis.Results Forty-one children with VL were from different provinces,including Shaanxi Province(70.73%(29/41)),Gansu Province(14.63%(6/41)),Shanxi Province(12.20%(5/41))and Ningxia Hui Autonomous Region(2.44%(1/41)),and 87.80%(36/41)of them lived in rural areas.The peak age was>1.0 to 3.0 years old(63.41%(26/41)).They were sporadic throughout the year.The main clinical manifestations included fever(97.56%(40/41)),splenomegaly(95.12%(39/41)),lymphadenopathy(82.93%(34/41))and hepatomegaly(60.98%(25/41)).The numbers of cases that Leishman-Donovan bodies were detected in the first,second and third bone marrow smears were 36,four and one,respectively.Anemia,thrombocytopenia and leukopenia detected by blood routine test were 100.00%(41/41),78.05%(32/41)and 58.54%(24/41),respectively.There were statistically significant differences in the platelet count,lactate dehydrogenase,alanine aminotransferase,triglycerides,fibrinogen and ferritin between VL group(28 cases)and VL+HLH group(13 cases)(t=-2.56,t=2.64,Z=-2.66,t=7.15,t=-5.76 and t=3.86,respectively,all P<0.050).The proportions of hepatomegaly and hemophagocytes found in the bone marrow smears in VL group were both lower than tho

关 键 词：利什曼病 内脏 儿童 淋巴组织细胞增多症 嗜血细胞性 锑 

分 类 号：R181.3[医药卫生—流行病学] R725.1[医药卫生—公共卫生与预防医学]