39例输入性疟疾的临床分析

Clinical analysis of 39 imported malaria cases

目的分析输入性疟疾患者的临床特征,实验室检查结果及治疗策略,为疟疾防控及诊治提供经验。方法收集2012年7月至2019年12月广西医科大学第一附属医院收治的39例输入性疟疾患者的临床资料,对患者的一般情况、临床表现、实验室检查、诊断治疗情况等进行回顾性分析。结果39例患者中男性37例,女性2例,平均年龄(38.79±9.74)岁。其中,恶性疟20例,间日疟3例,恶性疟混合间日疟2例,卵形疟1例,三日疟1例,分型不详12例。所有患者均有发热症状,乏力(占74.36%)、头痛(占33.33%)、脾大(占30.77%)、恶心呕吐(占28.21%)等为常见临床症状,17例患者出现相关并发症。患者经治疗后血红蛋白水平[(99.94±23.06)g/L]较治疗前[(116.97±28.30)g/L]降低,差异有统计学意义(t=2.6561,P<0.05),血小板[(209.24±100.31)×10^9/L]较治疗前[(102.12±86.98)×10^9/L]升高,差异有统计学意义(t=-4.6801,P<0.001)。38例患者选用以青蒿琥酯为基础的治疗,除1例恶性疟重症患者死亡外,其余患者治愈出院。结论输入性疟疾感染虫种主要是恶性疟原虫,常合并多种并发症,尽早识别及诊断疟疾是治疗的关键。其治疗后出现血小板升高和血红蛋白降低具有显著意义,值得进一步研究。

Objective To analyze the clinical characteristics,results of laboratory examination and treatment strategies of patients with imported malaria,to provide experience for malaria prevention,control,diagnosis and treatment.Methods Collected clinical data of 39 imported malaria patients admitted to the First Affiliated Hospital of Guangxi Medical University from July 2012 to December 2019,the patient′s general condition,clinical manifestations,laboratory examinations,diagnosis and treatment were retrospectively analyzed.Results The 39 patients included 37 males and 2 females.Their average age was(38.79±9.74)years old.There were 20 cases with falciparum malaria,3 cases with vivax malaria,2 cases with mixed infection by falciparum malaria and vivax malaria,1 case with malaria ovale,1 case with malariae infection,and 12 cases with unknown type.All patients had fever symptoms.The common symptoms included fatigue(74.36%),headache(33.33%),splenomegaly(30.77%),nausea and vomiting(28.21%),et al.Complications occurred in 17 patients.After treatment,the patient′s hemoglobin level[(99.94±23.06)g/L]was lower than before treatment[(116.97±28.30)g/L],the difference was statistically significant(t=2.6561,P,<0.05),and platelets increased in after treatment[(209.24±100.31)×10^9/L]compared to before treatment[(102.12±86.98)×10^9/L],the difference was statistically significant(t=-4.6801,P<0.001).Thirty-eight patients were treated with artesunate-based treatment.Except for one death,the rest were cured and discharged.Conclusion Falciparum malaria is the main infectious species in imported malaria cases,which has many complications.Early identification and diagnosis of malaria is the key to treatment.The phenomenon of increased platelets and decreased hemoglobin after treatment of imported malaria is of significant significance and is worthy of further study.