儿童恙虫病继发噬血细胞综合征15例临床分析  

Analysis of clinical characteristics of scrub typhus associated with hemophagocytic syndrome in 15 children

作　　者：路伟民 杨小涛[1] 赵明波[1] 黄艺 胥露 金海凤 王艳春[1] LU Wei-min;YANG Xiao-tao;ZHAO Ming-bo;HUANG Yi;XU Lu;JIN Hai-feng;WANG Yan-chun(The 2nd Department of Infectious Disease,Kunming Children's Hospital,Kunming,Yunnan 650034,China;School of Clinical Medicine,Dali University,Dali,Yunnan 671000,China)

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

出　　处：《中国热带医学》2023年第3期255-259,共5页China Tropical Medicine

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(No.202101AY070001-217);昆明市卫生科技人才培养项目暨“十百千”工程培养计划[No.2020-SW(省)-21]。

摘　　要：目的分析儿童恙虫病继发噬血细胞综合征(hemophagocytic syndrome,HPS)患者临床特征。方法回顾性分析昆明市儿童医院2019年1月1日至2021年12月31日收治的恙虫病患者病例资料,按是否继发HPS分为HPS组和非HPS组,采用SPSS 25.0软件对两组患者临床资料进行分析。结果85例儿童恙虫病病例中,15例(17.6%)继发HPS,男性9例,女性6例,平均年龄为(5.10±3.82)岁;HPS与非HPS组在性别、年龄方面差异无统计学意义(P>0.05)。比较两组患者临床特征发现,HPS组咳嗽、肺部啰音、水肿、肝脏增大发生率高于非HPS组,差异有统计学意义(P<0.05);实验室数据显示,与非HPS组相比,HPS组血红蛋白(hemoglobin,HGB)、血小板(platelet,PLT)、白蛋白(albumin,ALB)、纤维蛋白原(fibrinogen,Fib)下降,C-反应蛋白(C-reactive protein,CRP)、乳酸脱氢酶(lactic dehydrogenase,LDH)、甘油三酯(triglyceride,TG)、血清铁蛋白(serum ferritin,SF)升高,差异均有统计学意义(P<0.05);HPS组CD3^(+)、CD8^(+)T淋巴细胞占比升高,CD4^(+)T淋巴细胞占比降低,CD4^(+)/CD8^(+)降低,与非HPS组相比差异有统计学意义(P<0.05)。HPS组影像学显示肺部渗出或实变比例高于非HPS组,差异有统计学意义(P<0.05)。所有继发HPS患者均口服盐酸多西环素治疗,13例(86.7%)予静注人免疫球蛋白。14例好转,1例死亡。结论HPS是儿童恙虫病不容忽视的并发症,恙虫病儿童出现持续发热、肺部啰音、肝脏增大、HGB下降、PLT减少、SF增高、淋巴细胞亚群异常有可能继发HPS,同时流行地区表现为HPS的患儿需警惕恙虫病,及时抗感染和免疫调节剂治疗可改善预后。Objective To analyze the clinical features of hemophagocytic syndrome(HPS)associated with Orientia tsutsugamushi disease in children.Methods The case data of patients with scrub typhus in Kunming Children's Hospital from January 1st 2019 to December 31st 2021 was retrospectively analyzed.The patients were divided into the HPS group and the non-HPS group according to whether associated with HPS.The clinical data of the two groups were analyzed using SPSS 25.0.Results Eighty-five cases of scrub typhus in children were collected,15 cases(17.6%)had HPS.The mean age of patients with HPS was(5.10±3.82)years,included 9 males and 6 female,there was no significant difference in gender and age between the HPS and the non-HPS group(P>0.05).Comparison of the two groups indicted that the incidence of cough,lung rales,edema,and hepatomegaly were significantly increased in the HPS group(P<0.05).The data showed that compared to the non-HPS group,the HPS group showed significant decreases in the levels of hemoglobin(HGB),platelet(PLT),albumin(ALB),fibrinogen(Fib)(P<0.05),and significant decreases in the levels of C-reactive protein(CRP),lactic dehydrogenase(LDH),triglyceride(TG),serum ferritin(SF)(P<0.05).The proportion of CD4^(+)T lymphocytes,CD4^(+)/CD8^(+)were significantly decreased(P<0.05);the proportion of CD3^(+),CD8^(+)T lymphocytes were significantly increased(P<0.05).The proportion of pulmonary exudation or consolidation in the HPS group was higher than the non-HPS group,which was statistically significant(P<0.05).All the patients with scrub typhus associated with HPS were treated with oral doxycycline,and intravenous immunoglobulin was given in 13 cases(86.7%).There was one case of death and 14 cases discharged from hospital after treatment in HPS group.Conclusion HPS in scrub typhus infected children is a nonnegligible complication.Prolonged fever,lung rales,hepatomegaly,HGB decreased,thrombocytopenia,hyperferritinemia,and abnormal lymphocyte subsets may associate with HPS.It should be alerted to scrub typhus when pr

关 键 词：恙虫病 噬血细胞综合征 临床特征 儿童 

分 类 号：R725.1[医药卫生—儿科]