儿童黑热病23例流行病学及临床特征分析

摘要

Objective To explore the epidemiological and clinical characteristics of pediatric kala -azar aiming to provide a reasonable basis for reducing clinical misdiagnosis and mistherapy .Methods Retrospective analysis was carried out on clinical and laboratory data of 23 children with pediatric kala-azar who were admitted in Xi’an Children’s Hospital from 1998 to 2012.Results All of 23 children had the history of living in epidemic areas .Individual occurrences of the disease covered every month of the year , most of which were in the period of May to September, accounting for 73.9%(17/23) of the annual total cases .More cases were found in male population , particularly in those who were under 6 years, accounting for 86.96%(20/23) of all the patients .The time lasting from onset of symptoms to diagnosis of the disease shorter than 4 months accounted for 95.6% (22/23) of all the patients, and the course of disease varied depending on the delay due to misdiagnose.The major clinical manifestations included long term irregular fever , progressive anemia, splenomegaly, pancytopenia ( significantly reduced white blood cells ) and increased level of plasma globulin .And leishmania was observed in bone marrow smears, for which antimonial agents were used with significant therapeutic effects .Conclusion Pediatric kala-azar causes multi-organ involvement without specific clinical manifestations .The children with fever for long term , splenomegaly and pancytopenia , especially those who come from or live in epidemic areas , should be diagnosed with the disease in case of no responses to conventional anti -infective therapy .Performing bone marrow aspiration in laboratory tests as early as possible is the key to avoid missed diagnosis and misdiagnosis .And sodium antimony gluconate is still considered as the first drug for this disease with significant therapeutic effects .%目的：探讨儿童黑热病的流行病学及临床特征特点，为减少误诊误治提供依据。方法对西安市儿童医院1998至2012年收治的23例儿童黑热病临床和实验室资料进行回顾性分析。结果23例患者均有流行区居住史；各月均有发病，以5至9月居多，占全年发病的73．9％（17/23）；男性多于女性，年龄以6岁以下发病者较多，占发病数的86．96％（20/23）；从发病至确诊时间在4个月内的占95．6％（22/23），病程长短与误诊时间有关；主要临床表现为长期不规则发热、进行性贫血和脾肿大，以白细胞为主的全血细胞减少及血浆球蛋白增高。骨髓涂片均检出利什曼原虫，锑剂治疗效果显著。结论儿童黑热病受累脏器多，临床表现虽无特异性，对于长期发热、脾脏肿大和全血细胞减少，特别是来自疫区或在疫区有居住史，在普通抗感染治疗无效的情况下，须考虑到此病。尽早行骨髓穿刺实验室检查，是避免漏诊、误诊的关键，葡萄糖酸锑钠仍然是首选药物，治疗效果显著。