恙虫病并发多脏器损害167例临床分析

Clinical Analysis on 167 Cases of Tsutsugamushi Disease Complicated with Multiple Organ Damage

目的探讨深圳地区恙虫病并发多脏器损害的特征及误诊情况。方法对1990年9月至2004年11月深圳地区收治的恙虫病并发多脏器损害167例患者进行回顾性分析。结果3个器官损害92例,占55.1%;4个器官损害46例,占27.5%;5个器官损害24例,占14.4%;6个以上器官损害5例,占3.0%。在器官损害方面肝脏损害最常见,为73.7%(123/167),其次为肺损害,为58.6%(98/167),心脏损害和肾脏损害也较常见,分别为52.7%(88/167)、35.9%(60/167)。病情危重程度与器官损害数目成正相关。及时诊治,预后良好,治愈率94.6%。9例因基础疾病或诊治延误合并多器官功能障碍(MODS)死亡,病死率5.4%。结论恙虫病临床表现复杂多样,常伴发多器官损害,其中以肝脏、肺、心脏和肾脏损害最常见,应仔细分析病情,及时正确诊治。

Objective To explore the characteristics of tsutsugamushi disease complicated with multiple organ damage and its misdiagnosis in Shenzhen area. Methods 167 cases of tsutsugamushi disease accompanied by multiple organ damage were retrospectively studied from Sep. 1999 to Nov. 2004 in Shenzhen area. Results Among the 167 cases of tsutsugamushi disease accompanied by multiple organ damage, there were 92 cases of 3-organ damage （55.1%）, 46 cases of 4-organ damage （27.5%）, 24 cases of 5-organ damage （14.4%）, 5 cases of over 6-organ damage （3.0%）. Liver damage occupied the most common cases among the organ damage cases, accounting for 73.7%, following by lung damage （58.6%）, heart damage （52.7%） and kidney damage （35.9%）. Through the reinforcement of the appropriate diagnosis and treatment of various complications, the prognosis was favorable and the curative rate was 94.6%. Nine cases died from the primary diseases or the delay of diagnosis and treatment accompanied by multiple organ dysfunction syndrome （MODS） with the death rate being 5.4%. Conclusion The manifestation of tsutsugamushi disease is complicated and multiple, often accompanied by multiple organ damage, among which liver, lung, heart and kidney are the most common cases. Accurate analysis, appropriate diagnosis and treatment are absolutely necessary.