恙虫病并发肝损害的临床特征

Clinical characteristics of scrub typhus complicated with toxic hepatitis

目的分析恙虫病并发肝损害的临床特点。方法1990年3月至2005年6月温州医学院附属第一医院及附属第二医院共收治恙虫病49例,对其中并发肝损害的36例患者进行回顾性分析。结果36例恙虫病合并肝损害患者占同期恙虫病患者的73.5%,其中胃肠道症状有恶心呕吐12例,腹胀21例;36例患者血清ALT及AST均升高,其中血清TBil升高9例,血清碱性磷酸酶(ALP)升高16例,Alb降低14例;B型超声检查肝脏肿大13例,脾脏肿大16例,有腹水者9例。所有患者经氯霉素或四环素类片剂及保肝治疗均痊愈。结论恙虫病合并肝损害较常见,对不明原因发热伴肝损害的患者,应考虑恙虫病的可能。

Objective To analyze clinical characteristics of scrub typhus complicated with toxic hepatitis. Methods From 1990 to 2005, 49 patients diagnosed as scrub typhus in The First Affiliated Hospital and The Second Affiliated Hospital of Wenzhou Medical College were studied, and 36 of them had abnormal liver function. The medical records of these 36 patients were reviewed thoroughly. Results Hepatic dysfunction occurred in 73.5% （36/49） of patients. Among 36 scrub typhus cases complicated with toxic hepatitis, gastrointestinal manifestations included nausea and vomit（ 12/36, 33.3 % ） and abdominal distention （21/36, 58.3 % ）. Elevated serum alanine aminotransferase （ALT） and aspartate aminotransferase（AST） were observed in all cases, of which 9 cases （25. 0%） had elevated serum total bilirubin（TBil）. Furthermore, 16 cases（44.4%） had elevated alkaline phosphatase（ALP） and 14 cases（38.9% ） had decreased serum albumin（Alb）. Hepatomegalia was observed in 13 cases（36.1%）, splenomegalia in 16 cases（44.4%） and ascites in 9 cases（25.0%）. All cases were treated with chloramphenicolum or tablets tetracyclines and supportive liver protection therapy. All patients fully recovered. Conclusions Scrub typhus complicated with toxic hepatitis is common. For patients with fever of unknown origin and hepatocellular damage, the possibility of scrub typhus infection should be considered.