恙虫病并发肝损害的临床特征

Clinical characteristics of scrub typhus patients complicated with hepatic lesions

目的分析恙虫病并发肝损害的临床特点。方法2004年3月～2006年6月琼海市人民医院共收治恙虫病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 patients complicated with hepatic lesions. Methods From 2004 to 2006, 49 patients were diangnosed as scrub typhus in Qionghai Municipal People＇s Hospital and 36 cases with hepatic lesions were retrospectively analyzed. Results Scrub typhus complicated with hepatic lesions occurred to 73.5 % （36/49） of patients, gastrointestinnal manifestations including nausea and vomit occurre to 33.3% of the patients （12/36,） and abdominal distention（21/36,58.3 % ） . Elevated serum alanine aminotransferase （ ALT ） and aspartate aminotransferase （ AST ） were observed in allthe 36 cases. Of which 9 eases （25.0 % ） had elevated serum total bilirubin （ TBil）, 16 cases （44.4 % ） had elevated alkaline phosphatase（ALP） and 14 eases （38.9%） had decreased serum albumin（Alb）. Hepatomegaly was observed in 13 eases（36：1% ）, splenomegalia in 16 eases（44.4% ） and ascites in 9 cases（2.5.0% ）. All cases were cured after treated with chloramphenicolum or tetracycline tablets and supportive liver protection therapy. Conclusion Scrub typhus complicated with hepatitis is commmon. Patients with fever of unknown origin and hepatocellular damage, the possibility of scrub typhus infection should be considered.