112例恙虫病临床分析

Clinical analysis of 112 cases of tustsugamushi disease

目的 :探讨恙虫病的诊治特点。方法 :对我院近十年来收治资料完整的恙虫病 112例进行临床分析。结果 :以农民多见 (76 .8% ) ,所有患者发病前均有草地等野外活动史。发病以 6～ 10月多见占 6 4 .3%。临床以发热 (10 0 % )、焦痂及溃疡 (88.4 % )、淋巴结肿大 (70 .5% )、皮疹 (37.5% )和肝脾肿大 (50 .9% )为主。辅助检查可出现白细胞升高 (31.3% ) ,血沉增快 (86 .6 % ) ,尿RBC阳性 (5.4 % ) ,蛋白阳性 (5.4 % )。外斐反应阳性 (87.5% ) ,ALT升高 (52 .7% )等。误诊 37例 ,误诊率 33.0 %。主要误诊为肾炎、肝炎、肺炎等。治疗均用强力霉素、氯霉素、泰利必妥等 ,2例因多脏器功能衰竭死亡 ,治愈率 98.2 %。结论 :恙虫病临床表现多样复杂 ,误诊率高 ,提高对本病的认识 ,做到早诊断、早治疗是改善预后的关键。

Objective: To study the characteristic of tustsugamushi disease's diagnosis and therapy. Methods: Analysis of complete treatment data of 112 cases of tustsugamushi disease patients in our hospital recent decade. Results: 76.8% of the cases was farmer with history of activing in grass plot, and 64.3% of the cases incidented within six or ten month. The main clinical symptom was pyrexia (100.0%), eschar and ulcer (88.4%), enlarged lymph rodes (70.5%), tetter(37.5%)、hepatomegalg and splenomegaly. Investigation: leukocyte increase (31.3%), erythrocyte sedimentation rate (ESR) increase (86.6%), urine RBC masculine (5.4%), urine album masculine (5.4%), Wei-Felix reaction masculine (87.5%), ALT increase (52.7%) et al. 37 cases of which were misdiagnosised with nephritis、hepatitis、pneumonia. The healing rate was 98.2%. Only 2 cases died of multi organ failure in use of chloromycetin, doxycycline, ofloxacin et al. Conclusions: The clinical manifestions of acariasis were complicated .The misdiagnosis rate was high. To improve cure rate, serious analysis、early diagnosis and treatment were the key.