小儿蚕豆病73例临床分析

Clinical Analysis of 73 Cases of Children with Favism

目的分析小儿蚕豆病的临床特点及治疗效果,加强对小儿蚕豆病的认识。方法选取1995—2011年我院收治的73例小儿蚕豆病,回顾性分析其发病诱因、临床表现、实验室检查、治疗及预后。结果发病诱因:食用新鲜蚕豆64例,食用蚕豆粉丝3例,食用干蚕豆2例,母亲食用蚕豆后哺乳2例,食用蚕豆面条1例,食用蚕豆酱油1例。73例均先后出现皮肤、巩膜黄染,酱油样、葡萄酒样或浓茶样小便;68例合并口唇、睑结膜苍白;56例合并消化道症状:恶心、呕吐、腹痛、腹泻;55例合并发热,最高体温39.2℃。59例精神萎靡,2例深昏迷。血红蛋白均降低,白细胞计数、血小板计数均升高,尿隐血试验、尿蛋白均阳性。明确诊断后立即禁食蚕豆及蚕豆制品,禁服氧化类药物。均输血1～2次,碱化尿液、使用激素、处理并发症、维持水电解质酸碱平衡。14例痊愈,57例好转出院,2例因就诊时间较晚,合并多脏器功能衰竭死亡。结论蚕豆病是本地一种常见的溶血性疾病,临床表现及实验室检查主要是贫血的表现,治疗以去除诱因、输血、对症治疗为主,及时治疗大多预后良好。

Objective To analyze the characteristics and treatment for children with favism in order to strengthen the understanding of this disease. Methods Causes, clinical manifestations, laboratory test, treatment and prognosis were retro- spectively analyzed in 73 children with favism admitted to our hospital from 1995 to 2011. Results The causes of favism were ： eating fresh vicia faba （64 cases）, eating broad bean vermicelli （3 cases）, eating dry vicia faba （2 cases）, eating milk from mother who had eaten vicia faba （2 cases） , eating broad bean noodle （ 1 case） and eating broad bean soy sauce （ 1 case）. The 73 cases showed xanthochromia, icteric sclera, soy sauce, wine or strong tea - like urine. 68 cases had combined pale lips and palpebral conjunctiva, 56 cases had combined digestive tract symptoms like nausea, vomit, abdominal pain and diarrhea, 55 cases had combined fever with the highest temperature of 39. 2 ℃, 59 cases had dispiritedness and 2 cases had deep coma. All the patients had decreased hemoglobin, increased numeration of leukocyte and blood platelet count and positive urinary occult blood test and urine protein. After clarifying diagnosis, all the patients were prevented from eating vicia faba and its related prod- ucts as well as oxidation drugs. The patients were then given transfusion, alkalization of urine, hormone treatment, and treatment of complications and maintenance of electrolyte balance. In the end, 14 patients were released from hospital after recovery, 57 patients were released from hospital after improvement and 2 patients died due to late visiting time and multiple organ fail- ure. Conclusion Favism is a commonly seen hemolytic disease with clinical manifestations similar to anemia. The treatment of this disease includes the elimination of causes, transfusion and symptomatic treatment. Its prognosis is satisfactory if it can be treated in time.