重症恙虫病的临床特征分析

摘要

目的：探讨重症恙虫病的临床特征。方法选择2011年7月—2013年10月在赣州市人民医院住院恙虫病患者66例，根据重症诊断标准将患者分为重症组29例和非重症组37例。比较两组患者的临床表现、实验室检查、影像学检查和治疗及预后等。结果重症组呼吸困难、心悸、下肢水肿、肺部啰音、低血压发生率均高于非重症组（P＜0.05）。患者焦痂发生率为97.0％。重症组血小板（PLT）、清蛋白（Alb）水平低于非重症组，血肌酐（Scr）、尿素氮（BUN）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBiL）、肌酸激酶（ CK）、肌酸激酶同工酶（ CK-MB）、乳酸脱氢酶（ LDH）、降钙素原（ PCT）水平高于非重症组， ALT／AST比例倒置发生率高于非重症组（P＜0.05）。外斐反应OXK多在起病1周内检测，阳性率为14.7％（5／34）。重症组均行胸部X线检查，28例（96.6％）有肺部炎性渗出表现；22例（75.9％）有单侧或双侧胸腔积液。非重症组31例行胸部X线检查，19例（61.3％）有肺部炎性渗出表现；13例（41.9％）有单侧或双侧胸腔积液。重症组肺部炎性渗出、胸腔积液发生率均高于非重症组（P＜0.05）。重症组中10例（34.5％）肝大，19例（65.5％）脾大，8例（27.6％）有腹腔积液。非重症组中9例（24.3％）肝大，20例（54.1％）脾大，5例（13.5％）有腹腔积液。两组肝大、脾大、腹腔积液发生率比较，差异均无统计学意义（P＞0.05）。确诊后患者使用多西环素或四环素治疗。重症组热退时间为（4.3±2.2） d，高于非重症组的（2.7±1.8） d （ P＜0.05）。结论重症患者与非重症患者相比，呼吸困难、心悸、下肢水肿、肺部啰音、低血压发生率、 PLT、 Alb、 Scr、 BUN、 ALT、 AST、 TBiL、 CK、 CK-MB、 LDH、 PCT水平、发生ALT／AST比例倒置等指标有统计学差异，更易出现双肺受累及胸腔积液，热退时间更长。对于有重症倾向的患者应严密监测并积极治疗，以降低病死率。%Objective To identify the clinical features of severe scrub typhus patients . Methods A total of 66 patients with scrub typhus who were admitted into Ganzhou Renmin Hospital from July 2011 to October 2013 were enrolled.According to the diagnostic criterion of severe disease , the patients were divided into two groups: severe group ( n=29) and non -severe group ( n =37).Comparison was made between the two groups in clinical manifestation , laboratory examination, imageology examination, treatment and prognosis.Results Severe group was higher (P <0.05) than non -severe group in the incidence of dyspnea , palpitation , lower limb edema , rale in lung and hypotension .The incidence of eschar was 97.0%.Severe group was lower ( P<0.05 ) in the levels of PLT and Alb and higher ( P<0.05 ) in the levels of Scr , BUN, ALT, AST, TBiL, CK, CK-MB, LDH and PCT than non -severe group.Severe group was also higher ( P<0.05 ) than non-severe group in the incidence of the ratio inversion of ALT /AST.Weil-Felix OXK reaction was tested within one week after onset, with a positive rate of 14.7% (5/34).Through the chest X -ray examination conducted on all subjects in severe group, we noted inflammatory exudation in 28 ( 96.6%) subjects and unilateral or bilateral pleural effusion in 22 ( 75.9%) subjects.Chest X-ray examination was conducted on 31 subjects in non -severe group , by which we noted inflammatory exudation in 19 (61.3%) subjects and change of pleural effusion in 13 (41.9%) subjects.Severe group was higher ( P<0.05) than non-severe group in the incidence of inflammatory exudation and pleural effusion .In severe group, 10 (34.5%) subjects had hepatomegaly , 19 ( 65.5%) subjects had splenauxe , 8 ( 27.6%) subjects had seroperitoneum .In non -severe group, 9 ( 24.3%) subjects had hepatomegaly , 20 ( 54.1%) subjects had splenauxe , 5 ( 13.5%) subjects had seroperitoneum.The two groups had no significant difference (P>0.05) in hepatomegaly, splenauxe and seroperitoneum.After diagnosis, the subjects were treated with doxycycline and tetracycline .The time need for abating fever was (4.3 ±2.2) d for severe group, longer (P<0.05) than that of non-severe group which was (2.7 ±1.8) d.Conclusion Severe scrub typhus patients are significantly different from non -severe scrub typhus patients in the incidence of dyspnea , palpitation , lower limb edema, rale in lung and hypotension , in the levels of PLT, Alb, Scr, BUN, ALT, AST, TBiL, CK, CK-MB, LDH and PCT and in the incidence of the ratio reversion of ALT/AST.Severe scrub typhus patients are more likely to have double lung involvement , pleural effusion and longer time need for abating fever .Severe scrub typhus patients should be closely monitored and treated actively in order to reduce case fatality rate .