23例儿童黑热病临床分析

Clinical analysis of 23 cases of children with kala-azar

目的总结23例儿童黑热病的临床特点,以提高临床医师对儿童黑热病的认识。方法选择2005年3月至2017年4月,于四川大学华西第二医院诊断为黑热病的23例患儿为研究对象,对其临床表现、实验室检查结果、治疗及预后进行回顾性分析,总结儿童黑热病的临床特点。对于发热、咳嗽、贫血等临床表现的发生率等计数资料,采用率(%)表示。结果 (1)本组23例黑热病患儿,发病年龄主要集中于2～3岁,占56.5%(13/23);主要分布于四川省九寨沟县和黑水县,占39.1%(9/23);发病时间散在分布于全年。(2)本组23例黑热病患儿的主要临床症状依次为:发热(100.0%,23/23),咳嗽(73.9%,17/23),乏力(65.2%,15/23);主要体征依次为:贫血貌(69.6%,16/23),脾大(60.9%,14/23),淋巴结肿大(52.2%,12/23)。(3)本组23例黑热病患儿的主要实验室检查结果:全血细胞减少为85.7%(18/23),肝功能异常为30.4%(7/23),凝血功能异常为8.7%(2/23),骨髓穿刺涂片检查结果可见利杜小体为90.9%(20/22),rk39免疫层析试条法检测结果呈阳性为80.0%(16/20)。(4)本组23例黑热病患儿主要采用锑剂治疗,在本院治疗的18例患儿均痊愈出院,并且无复发。结论对于有发热、贫血、肝脾大的患儿,早期完善骨髓穿刺涂片检查、血清抗体检查等,是减少儿童黑热病漏诊及误诊的关键。临床对该病的规范治疗,有利于改善该病患儿预后。

To summarize the clinical characteristics of 23 cases of children with kala-azar,so as to raise the awareness of clinical physicians to children with kala-azar.Methods A total of 23 children with kala-azar from March 2005 to April 2017 in West China Second University Hospital,Sichuan University,were selected as study subjects.The clinical manifestations,laboratory test results,treatments and prognosis of 23 cases were retrospectively analyzed,and the clinical characteristics of children with kala-azar were summarized.For the incidences of fever,cough,anemia and other clinical manifestations were expressed by rate(%).Results①Among 23 cases of children with kala-azar,the main onset age was 2 to 3 years old,accounted for 56.5%(13/23).The children were mainly distributed in Jiuzhaigou County and Heishui County of Sichuan Province,accounted for 39.1%(9/23).The onset time of kala-azar was scattered throughout the whole year.②The main clinical symptoms of 23 children with kala-azar were as follows in turn:fever accounted for 100.0%(23/23),cough accounted for 73.9%(17/23),and lack of strength accounted for 65.2%(15/23).The main physical signs of 23 children with kala-azar were as follows in turn:anemia appearance accounted for 69.6%(16/23),splenomegaly accounted for 60.9%(14/23),and lymph node enlargement accounted for 52.2%(12/23).③Main laboratory test results of 23 children with kala-azar were as follows:pancytopenia accounted for 85.7%(18/23),abnormal liver function accounted for 30.4%(7/23),blood coagulation dysfunction accounted for 8.7%(2/23),lit-duchenne body founded in bone marrow smear accounted for 90.9%(20/22),and rk39 immunochromatographic strip test showed positive accounted for 80.0%(16/20).④The main treatment of 23 children with kala-azar was antimony intramuscular injection or intravenously guttae,and all 18 children treated in our hospital were healed and discharged from hospital without recurrence.Conclusions For children with fever,anemia and hepatosplenomegaly,early perfection of bone marrow biopsy smears and serum antibody examination are keys to reduce the missed diagnosis and misdiagnosis of children with kala-azar.And standardized treatment is beneficial to improve the prognosis of children with kala-azar.