11例儿童内脏利什曼病临床分析

Clinical analysis of eleven children with visceral leishmaniasis

目的:分析11例内脏利什曼病(VL)患儿临床表现和实验室的特点,以提高本病的早期诊断率和治愈率。方法:回顾性分析2009年3月—2015年7月山西省儿童医院收治的11例VL患儿的临床资料。结果:患儿发热(12.27±8.28)d,脾脏增大(5.86±3.04)cm;白细胞计数为(2.80±1.39)×10~9/L;血红蛋白(63.91±11.75)g/L;血小板(55.36±30.37)×10~9/L;中性粒细胞的绝对值(0.41±0.37)×10~9/L;甘油三酯(3.08±1.66)mmol/L,纤维蛋白原(1.96±1.06)g/L;乳酸脱氢酶(520.64±245.40)U/L;血清铁蛋白的中位数为1 326μg/L;11例患儿骨髓涂片均可见噬血细胞。11例VL患儿均符合噬血细胞性淋巴组织细胞增生症(HLH)诊断,但确诊VL后,静脉滴注特效药葡萄糖酸锑钠1~2个疗程,临床病情痊愈;2例患儿合并皮肤利什曼病(CL),1例严重者进行局部植皮手术。结论:VL患儿临床表现均与HLH相似,并可继发死亡率高的VL-HLH,由于全球人员流动范围较广,临床诊断HLH时,要详细了解患儿流行病学资料,进行rk39试纸条等免疫学检测,必要时复查骨髓涂片,有助于VL患儿早期诊断和精准治疗,并减少并发症。

Objective： To analyze the clinical and laboratory features of eleven cases visceral leishmaniasis（ VL）,and improve the early diagnosis rate and cure rate. Methods： From March 2009 to July 2015,eleven cases of VL children from Children＇s Hospital of Shanxi,were analyzed retrospectively. Results： The mean plus or minus standard deviation offever days were（12.27±8.28）d;splenomegaly was（5.86±3.04）cm;white blood cells was（2.80±1.39）×109/L;hemoglobin was（63.91±11.75）g/L;platelet was（55.36±30.37）×109/L;neutrophil was（0.41±0.37）×109/L;triglyceride was（3.08±1.66）mmol/L,and fibrinogen was（1.96±1.06）g/L;lactate dehydrogenase was（520.64±245.40）U/L;the median of serum ferritin was 1 326μg/L.In the bone marrow,eleven young patients were found to have phagocytic cell.So all the eleven VL children was supported by laboratory tests of heoph-agocytic lymphohistocytosi（HLH）,but had diagnosed VL after inspected the Leishman-Donovani body from the bone marrow smear,and treatedwith one to two courses sodium stibogluconate injection,all young patients were cured,Only two children complicated cutaneous leishmaniasis,and one severe child were given skin transplantation.Conclusion：Clinical manifestations of VL children were similar to that of HLH,and VL secondary HLH（VL-HLH）with high death rate,When diagnosing Young patients with HLH,because wide range flowing of global personnel,collecting moredetail edepidemiological data,combining the rK 39 dipstick and other immune test,and repeating bone marrow studies,contributing to the early diagnose and precise treatment of children infected by VL,and reducing its complication.