1例黑热病患儿的循证诊断和治疗

摘要

Objective To diagnose quickly and make an individualized therapeutic regimen for a child suspected visceral leishmaniasis by the evidence-based method. Methods Combining with clinical problems of the child and according to PICO (patient, intervention, comparison and outcome) principle, relavent literatures which were searched from official website of China' s Center for Disease Control and Prevention, Cochrane Library, PubMed, Embase and CBM were collected and studied. Then, regime of diagnosis and treatment were defined taking into consideration of parents' intention and clinical experience. Results Evidence shows that the diagnostic performance of rK39 immunochromatography (rK39 ICT) for visceral leishmaniasis is excellent. In China, sodium stibogluconate (SSG) is still the first-line drug used for patients with visceral leishmaniasis. rK39 ICT and bone marrow cytology were taken to diagnose visceral leishmaniasis after informed consent got from parents, then the child was given SSG. Evident improvement of symptoms was achieved without adverse events of SSG and amastigotes of Leishmania donouani was not found by reexamination of bone marrow cytology. Conclusions Evidence-based clinical practice can solve clinical problems quickly and accurately.%目的 借助循证医学方法明确诊断疑似黑热病患儿并拟定治疗方案.方法 针对1例患儿临床问题,遵循循证临床实践的PICO原则(患者或问题、干预措施、对照干预措施及结局指标),检索中华人民共和国卫生部和中国疾病控制中心官网,Cochrane Library,PubMed,Embase和CBM,收集和评价文献以取得当前最佳证据,并结合临床经验及患儿家属的意愿,拟定诊断及治疗方案.结果 经循证分析,rK39免疫层析(rK39 ICT)诊断黑热病的检验效能高,快速、简单；葡萄糖酸锑钠仍可作为黑热病患者治疗的一线药物.在获得家属知情同意后,采用rK39 ICT和骨髓细胞学检查,快速明确诊断后给予葡萄糖酸锑钠治疗,患儿症状明显好转,未出现锑剂的不良反应,骨髓细胞学复查未见杜氏利什曼原虫无鞭毛体.结论 循证临床实践可以快速而准确地解决临床问题.