昆明市59例恙虫病患者的临床特征分析

Clinical features of 59 patients with scrub typhus in Kunming City

目的分析恙虫病患者的临床特点，为临床诊断及治疗提供依据。方法采用回顾性分析方法，收集2016年1-12月昆明医科大学第一附属医院收治的恙虫病患者的临床资料，分析患者的流行病学特征、临床特征、实验室检查、影像学检查、治疗及转归。结果共收集59例恙虫病病例，临床表现主要有发热C59例（100．0％）]、头痛[44例（74．6％）]、寒战[39例（66．1％）]、全身肌肉关节酸痛[34例（57．6％）]、乏力[29例（49．2％）]，焦痂或溃疡[49例（83．1％）]、淋巴结肿大[42例（71．2％）]、肝脾肿大[23例（39．0％）]。实验室检查：白细胞（WBC）正常或升高51例（86．4％），嗜酸性粒细胞降低50例（84．7％），血小板（PLT）降低29例（49．2％），白蛋白（ALB）降低33例（55．9％），丙氨酸氨基转移酶（ALT）升高50例（84．7％），天门冬氨酸氨基转移酶（AST）升高48例（8t．4％）：甲状腺激素检查：56．1％（23／41）的患者异常，以游离三碘甲状腺原氨酸（FT3）降低为主（82．6％，19／23）；C反应蛋白（CRP）、降钙素原（PCT）、红细胞沉降率（ESR）、铁蛋白升高率分别为93．9％（46／49）、35．4％（17／48）、64．9％（24／37）、83.8％（31／37）；患者胸部影像学检查结果异常占95．6％（43／45）。四环素、多西环素、阿奇霉素治疗均有效。结论恙虫病患者临床表现多样，常合并多个系统损害，可出现甲状腺激素改变．早期诊断及治疗是改善恙虫病患者临床预后的关键。

Objective To study the clinical features of patients with scrub typhus and provide scientific basis for clinical diagnosis and treatment. Methods Clinical data of patients with scrub typhus in the First Affiliated Hospital of Kunming Medical University from January 2016 to December 2016 were collected. Epidemiological data, clinical manifestations, laboratory findings, image examination results, treatment and outcome were retrospectively analyzed. Results The clinical manifestations included 59 cases （100.0%） with fever, 44 cases （74.6%） with headache, 39 cases （66.1%） with chills, 34 cases （57.6%） with muscle and joint pain, 29 cases （49.2%） with prostration, 49 cases （83.1%） with eschar or ulcer, 42 cases （71.2%） with lymphadenectasis, 23 cases （39.0%） with hepatosplenomegaly. Laboratory test results： 51 cases （86.4%） had normal or elevated white blood cell count, 50 cases of eosinophil reduced （84.7%）, 27 cases of blood platelet （PLT） reduced （45.8%）, 33 cases of albumin reduced （55.9%）, 50 cases of alanine aminotransferase （ALT） increased （84.7%）, 48 cases of aspartate aminotransferase （AST） increased （81.4%）, and 56.1% （23/41） of the patients with triiodothyronine （T3）, thyroxine （T4）, free triiodothyronine （FT3） and free thyroxine （FT4） levels significantly lowered, with predominantly free FF3 reduction （82.6%,19/23）; C reactive protein （CRP）, procalcitonin （PCT）, erythrocyte sedimentation rate （ESR） and ferritin were increased in 93.9% （46/49）, 35.4% （17/48）, 64.9% （24/37）, and 83.8% （31/37） of the patients, and 95.6%（43/45） was accompanied with chest radiographic abnormalities. Tetracycline, doxycycline and azithromycin treatment were all effective. Conclusions The clinical manifestations of patients with scrub typhus, involving muhisystem, are diverse and thyroid hormones decrease is observed. Early diagnosis and treatment is the key to improve theprognosis of patients with scrub typhus.