摘要
目的探讨伴噬血细胞综合征(HPS)表现的婴幼儿利什曼原虫感染的临床诊断、治疗和预后。方法对2007年12月至2009年12月新疆维吾尔自治区人民医院儿科收治的16例伴HPS表现的婴幼儿,通过分析其临床表现、实验室检测结果,结合其居住地,提出病因诊断及治疗措施。结果 16例均来自新疆塔里木盆地地区。其临床表现、实验室检测均符合HPS的诊断。其中骨髓检测找到利杜体(利什曼原虫)9例,血清利什曼原虫基因表达产物(rK39)-酶联免疫吸附实验(ELISA):检测结果阳性14例。16例中2例最初误诊为家族性HPS,治疗无效死亡。其后14例患儿因被确诊为内脏利什曼原虫感染所致的黑热病,给予葡萄糖酸锑钠治疗,均达到临床治疗有效标准。结论新疆塔里木盆地地区的婴幼儿HPS,应该首先考虑利什曼原虫感染所致。血清rK39-ELISA检测结果可协助诊断利什曼原虫感染。伴HPS表现的婴幼儿利什曼原虫感染,病情凶险,如误诊可在短时间内死亡。
Objective To investigate the clinical diagnosis treatment and prognosis of young children infected by leishmania with hemophagocytic syndrome (HPS) in Xinjiang. Methods During December 2007and December 2009, 16 patients of young children with HPS were hospitalized in the Pediatric Department of the People' s Hospital, Xinjiang Uyghur Autonomous Region. The data of patients' habitation, clinical presentation and laboratory results were reviewed and analyzed. Results All the 16 patients came from the Tarim Basin in Xinjiang and the diagnosis was supported by laboratory tests. In nine patients, Lidou body (Leishmania donovani) were found in bone marrow, and in fourteen patients, serum rK39-ELISA (rK39: Leishmania donovani gene expression product; ELISA: enzyme-linked immunosorbent assay) test was positive. The first two cases among thesel6 patients were misdiagnosed as familial HPS, who had no response to the treatment and died. The other 14 cases were diagnosed as Assam fever caused by visceral leishmania, and sodium antimony gluconate was administered. Fourteen patients were cured. Conclusion In the Tarim Basin, in young patients with HPS the visceral leishmania infection should first be considered. Serum rK39-ELISA test is helpful in the diagnosis of Leishmania infection. The HPS Assam fever in young children is often emergent and severe; the children would die quickly unless an early diagnosis were made and appropriate treatment were given.
出处
《中国实用儿科杂志》
CSCD
北大核心
2010年第11期871-873,共3页
Chinese Journal of Practical Pediatrics
关键词
婴幼儿
噬血细胞综合征
利什曼原虫
infant
hemophagocytic syndrome
leishmaniasis parasite