儿童恙虫病血液系统改变的临床研究以及误诊分析

Clinical Characteristics and Analysis of the Misdiagnosis about Hematological Changes with Tsutsugamushi Disease in Children

目的:分析我院7年来儿童恙虫病病例的临床特征,探讨血液系统改变在儿童恙虫病诊断中的意义。方法:回顾性分析我院收住的28例恙虫患儿的临床资料,尤其是血液系统损害的临床表现及实验室检查异常结果等。结果:血液系统改变主要表现为25例出现不同程度的肝肿大,11例出现脾大,12例浅表淋巴结肿大。实验室结果异常主要表现为18例血小板下降,其中10～20×109/L1例,20～50×109/L5例,80～100×109/L12例,正常10例;18例行凝血功能检查,其中11例凝血酶原时间、部分凝血酶原时间延长,伴纤维蛋白原下降;外周血白细胞上升8例,下降8例,正常12例;血红蛋白下降10例,90～110g/L 8例,80～90g/L2例。20例行骨髓穿刺检查,骨髓常规10例示正常骨髓象,10例示感染性骨髓象或增生性骨髓象。结论:恙虫病在儿童中发病率不高,临床表现差异较大,并发症多,血液系统损害突出,给临床医师造成困扰,常致误诊或漏诊,延误病情,可因多脏器功能衰竭而死亡。

Objective： To explore the clinical characteristics of children with tsutsugamushi disease in our hospital for 7 years and the significance of the hematological changes in the diagnosis of tsutsugamushi dis- ease in children. Methods. The clinical data of 28 children with Tsutsugamushi disease in our hospital were retrospectively analyzed, especially the clinical manifestation and laboratory data of hematological system. Results： The main manifestations of hematological changes were that hepatomegaly occurred in 25 cases in different degree, splenomegaly in 11 cases and superficial lymph node enlargement in 12 cases. The main ab- normal laboratory results showed 18 cases with platelet decline, including 1 case declining by 10-20×109// L, 5 cases by 20-50×109/L , 12 cases by 80-100×109/L, and 10 normal cases; coagulation were tested in 18 cases, and the prothrombin time and activated partial thromboplastin time extended in 11 cases with fi- brinogen declining; peripheral blood leukocytes increased in 8 cases and declined in 8 cases, while 12 cases were normal; Hemoglobin declined in 10 cases, of which 8 cases declined by 90-110g/L, and 2 cases de- clined by 80-90g//L. The bone marrow examinations were performed in 20 cases. The results showed that 10 cases were normal and infective myelogramm or proliferative myelogramm were found other 10 cases. Con- clusion： The incidence of tsutsugamushi disease in children is not high. It has varied clinical manifestations, more complications, and obvious hematological damage, which often disturbs the clinician, causes misdiag- nosis or missed diagnosis, and delays in the treatment. Therefore patients will die due to multiple organ function failure.