成人重症型水痘死亡患者临床检验资料回顾性分析

Retrospective analysis of clinical laboratory data of an adult dead patient with grave varicella

目的回顾性分析成人重症水痘死亡病例,探讨检验指标在重症水痘病情监测与治疗干预中的作用。方法回顾性分析病例并对临床检验数据进行统计学分析。结果患者总T细胞含量先高后低,至临终前跌幅达7倍以上;T4细胞含量减低,随病情恶化逐渐降至极低水平;T8细胞含量增高,但临终前下降5倍以上;CD4+/CD8+始终处于低值水平,CD4+/CD8+低于0.2出现4次;双阴性T细胞含量正常,双阳性T细胞含量升高;B细胞和NK细胞含量处于低值水平。尿素氮在临终前数日开始升高,天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、D二聚体、动脉氧分压、心肌肌钙蛋白I、超敏C反应蛋白(hsCRP)变化明显。结论成人重症水痘检验指标改变呈多样性,涉及反映细胞免疫、感染、止凝血、心肝肾损害的多项指标,T细胞及其亚群和hsCRP是反映患者病情、监测疗效和预后的最佳指标。

Objective To retrospectively analyze the clinical laboratory data of an adult dead patient with grave varicella.Methods Reviewing the medical record and collecting the clinical laboratory data.The data were analyzed by statistics treatment.Results Total T-cell increased abnormally in the early days and then decreased gradually to more than seven times in extrimis.T4 cell was in a lower level,and fall-off to the lowest level in extrimis.T8 cell was in a higher level,and fall more than five times in extrimis.CD4＋/CD8＋ was all along in a low level,and there were four times that the ratio less than 0.2.DNT were normal and DPT increased.B cells and NK cells were all along in a low level.Among conventional indexes,BUN began to increase ahead of several days before in extrimis.The others such as AST,ALT,DD,PO2,cTnI and hsCRP all had obviously changes during the course of disease.Conclusion The changes of clinical laboratory indexes could be diverse in adult grave vericella.There might be indexes related with cellular immune function,infection,haemostasis and blood clotting,organ injury,etc.Among all indexes,T-cells and its subgroups as well as hsCRP might be the best indexes to reflect the patient＇s condition,monitoring the curative effect and prognosis.