重症恙虫病的临床特征分析

Clinical Features of Severe Scrub Typhus Patients

目的探讨重症恙虫病的临床特征。方法选择2011年7月—2013年10月在赣州市人民医院住院恙虫病患者66例,根据重症诊断标准将患者分为重症组29例和非重症组37例。比较两组患者的临床表现、实验室检查、影像学检查和治疗及预后等。结果重症组呼吸困难、心悸、下肢水肿、肺部啰音、低血压发生率均高于非重症组(P<0.05)。患者焦痂发生率为97.0%。重症组血小板(PLT)、清蛋白(Alb)水平低于非重症组,血肌酐(Scr)、尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBi L)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、降钙素原(PCT)水平高于非重症组,ALT/AST比例倒置发生率高于非重症组(P<0.05)。外斐反应OXK多在起病1周内检测,阳性率为14.7%(5/34)。重症组均行胸部X线检查,28例(96.6%)有肺部炎性渗出表现;22例(75.9%)有单侧或双侧胸腔积液。非重症组31例行胸部X线检查,19例(61.3%)有肺部炎性渗出表现;13例(41.9%)有单侧或双侧胸腔积液。重症组肺部炎性渗出、胸腔积液发生率均高于非重症组(P<0.05)。重症组中10例(34.5%)肝大,19例(65.5%)脾大,8例(27.6%)有腹腔积液。非重症组中9例(24.3%)肝大,20例(54.1%)脾大,5例(13.5%)有腹腔积液。两组肝大、脾大、腹腔积液发生率比较,差异均无统计学意义(P>0.05)。确诊后患者使用多西环素或四环素治疗。重症组热退时间为(4.3±2.2)d,高于非重症组的(2.7±1.8)d(P<0.05)。结论重症患者与非重症患者相比,呼吸困难、心悸、下肢水肿、肺部啰音、低血压发生率、PLT、Alb、Scr、BUN、ALT、AST、TBi L、CK、CK-MB、LDH、PCT水平、发生ALT/AST比例倒置等指标有统计学差异,更易出现双肺受累及胸腔积液,热退时间更长。对于有重症倾向的患者应严密监测并积极治疗,以降低病死率。

Objective To identify the clinical features of severe scrub typhus patients . Methods A total of 66 patients with scrub typhus who were admitted into Ganzhou Renmin Hospital from July 2011 to October 2013 were enrolled.According to the diagnostic criterion of severe disease , the patients were divided into two groups： severe group （ n=29） and non -severe group （ n =37）.Comparison was made between the two groups in clinical manifestation , laboratory examination, imageology examination, treatment and prognosis.Results Severe group was higher （P 〈0.05） than non -severe group in the incidence of dyspnea , palpitation , lower limb edema , rale in lung and hypotension .The incidence of eschar was 97.0%.Severe group was lower （ P〈0.05 ） in the levels of PLT and Alb and higher （ P〈0.05 ） in the levels of Scr , BUN, ALT, AST, TBiL, CK, CK-MB, LDH and PCT than non -severe group.Severe group was also higher （ P＆lt;0.05 ） than non-severe group in the incidence of the ratio inversion of ALT /AST.Weil-Felix OXK reaction was tested within one week after onset, with a positive rate of 14.7% （5/34）.Through the chest X -ray examination conducted on all subjects in severe group, we noted inflammatory exudation in 28 （ 96.6%） subjects and unilateral or bilateral pleural effusion in 22 （ 75.9%） subjects.Chest X-ray examination was conducted on 31 subjects in non -severe group , by which we noted inflammatory exudation in 19 （61.3%） subjects and change of pleural effusion in 13 （41.9%） subjects.Severe group was higher （ P〈0.05） than non-severe group in the incidence of inflammatory exudation and pleural effusion .In severe group, 10 （34.5%） subjects had hepatomegaly , 19 （ 65.5%） subjects had splenauxe , 8 （ 27.6%） subjects had seroperitoneum .In non -severe group, 9 （ 24.3%） subjects had hepatomegaly , 20 （ 54.1%） subjects had splenauxe , 5 （ 13.5%） subjects had seroperitoneum.The two groups had no significant difference （P〉0.05） in hepatomegaly, splenauxe and seroperitoneum.After diagnosis, the subjects were treated with doxycycline and tetracycline .The time need for abating fever was （4.3 ±2.2） d for severe group, longer （P〈0.05） than that of non-severe group which was （2.7 ±1.8） d.Conclusion Severe scrub typhus patients are significantly different from non -severe scrub typhus patients in the incidence of dyspnea , palpitation , lower limb edema, rale in lung and hypotension , in the levels of PLT, Alb, Scr, BUN, ALT, AST, TBiL, CK, CK-MB, LDH and PCT and in the incidence of the ratio reversion of ALT/AST.Severe scrub typhus patients are more likely to have double lung involvement , pleural effusion and longer time need for abating fever .Severe scrub typhus patients should be closely monitored and treated actively in order to reduce case fatality rate .