1例儿童流行性出血热的临床实验室指标分析

Analysis of clinical laboratory indicators of epidemic hemorrhagic fever in a child

目的分析流行性出血热患儿临床表现和实验室检测指标,为缺乏典型临床特征的流行性出血热患儿的诊断提供参考依据。方法开展血常规、尿常规、生化和抗体等临床指标实验室检测。结果患儿入院时体温为39.5℃,精神反应稍弱。双眼睑轻度水肿,全身皮肤未见黄染、出血点,全身浅表淋巴结未触及。腹肌略紧张,腹部无压痛和反跳痛。实验室检查显示白细胞数量、中性粒细胞比例、C反应蛋白、血沉等参数数值升高,谷丙转氨酶和谷草转氨酶升高,中度蛋白尿和血尿,血清肌酐和尿素氮水平正常。RT-PCR结果显示血清汉滩病毒Ct值为30.37,患儿为汉滩病毒感染。两种ELISA诊断试剂结果均显示患者入院第1天血清汉坦病毒抗体IgM、IgG阴性,第7天与第15天为IgM阴性、IgG阳性。结论对于临床症状不典型,尤其是长期发热、炎症相关指标异常升高、转氨酶升高、出现蛋白尿和血尿的儿童,即使IgM型抗体持续阴性也不能排除汉坦病毒感染,应以临床症状联合实验室核酸检测及多次IgM和IgG抗体检测来评估。

Objective To analyze the clinical manifestations and laboratory indicators of epidemic hemorrhagic fever in a child,and provide a reference for the diagnosis of children with epidemic hemorrhagic fever lacking the typical clinical features.Methods Clinical indicators such as blood routine,urine routine,biochemical and antibody were tested in laboratory.Results On admission,the child temperature was 38.9℃,and mental response was slightly weak.There was mild edema of both eyelids,no yellowing or bleeding spots on the skin,and no superficial lymph nodes.The abdominal muscle was slightly tense,and there was no tenderness or rebound pain in the abdomen.Laboratory examination showed that some parameters increased,such as the number of white blood cells,the proportion of neutrophils,C-reactive protein,erythrocyte sedimentation rate,ALT and AST,moderate proteinuria and hematuria.The levels of serum creatinine and urea nitrogen were normal.RT-PCR results showed that the Ct value of serum hantavirus was 30.37,suggesting that the child was infected by hantavirus.The results of two ELISA diagnostic reagents showed that the levels of serum IgM and IgG of hantavirus were negative on the first admission day.However,IgM and IgG showed negative and positive result respectively on the seventh and fifteenth day.Conclusion For children with atypical clinical symptoms,especially long-term fever,abnormally elevated inflammation-related indicators,elevated transaminases,proteinuria and hematuria,hantavirus infection can’t be ruled out even if IgM antibodies continue to be negative.The clinical symptoms should be combined with laboratory RNA testing and multiple IgM and IgG antibody tests in the laboratory to assess the disease.