恙虫病重症化的危险因素分析

目的探讨恙虫病的临床特征及其重症化的危险因素:方法回顾性分析2015年1月至2019年12月70例恙虫病患者的临床资料;根据重症恙虫病的诊断标准将患者分为非重症组46例和重症组24例,比较两组患者的临床症状、实验室检查;分析重症恙虫病发生的危险因素。结果恙虫病患者临床症状多样化,所有患者均出现发热;体征方面以皮肤焦痂或溃疡最为常见,约占97.1%,其次为皮疹、淋巴结肿大及脾肿大。实验室指标常见血嗜酸粒细胞计数、白蛋白降低,丙氨酸转氨酶、天冬氨酸转氨酶及乳酸脱氢酶不同程度升高。重症组头晕头痛、胸闷发生比例与非重症组比较差异有统计学意义(P<0.05);重症组与非重症组比较,天冬氨酸转氨酶(P=0.020)、总胆红素(P=0.026)、肌酸激酶同工酶(P=0.008)水平明显升高,血小板计数(P=0.017)、白蛋白(P<0.001)水平明显下降。多因素Logistic回归分析,血小板计数减少(OR:0.911,P=0.030)、白蛋白降低(OR:0.570,P=0.003)、肌酸激酶同工酶升高(OR:1.153,P=0.025)是恙虫病重症化的危险因素。结论恙虫病患者临床症状多样化,体检常发现焦痂或溃疡、皮疹及淋巴结肿大,实验室指标发现嗜酸性粒细胞计数下降甚至为0伴丙氨酸转氨酶、天冬氨酸转氨酶升高有利于疾病诊断;血小板计数减少、低蛋白血症、肌酸激酶同工酶升高是恙虫病重症化的危险因素,对重症患者早期识别和处理具有重要临床意义。

Objective To explore the clinical characteristics and risk factors of severe scrub typhus in Lishui City,Zhejiang Province.Methods Collected 70 patients of scrub typhus who were admitted to Lishui Central Hospital from January 1,2015 to December 31,2019,and retrospectively analyzed their clinical symptoms and laboratory tests data.The patients were divided into the non-severe group and the severe group according to the diagnostic criteria,compared the clinical symptoms and laboratory examinations of the two groups.The variables with statistical differences between the two groups were included in the multivariate logistic regression analysis to explore the risk factors of severe scrub typhus.Results The clinical symptoms of patients with scrub typhus were various,all patients had different degrees of fever.In terms of physical signs,eschar or ulcer was the most common,which occurred in about 97.1%of patients,followed by rash,lymphadenopathy,and splenomegaly.The reduction of eosinophil count and albumin,elevation of alanine aminotransferase,aspartate aminotransferase and lactate dehydrogenase laboratory tests were easily to find.Statistical analysis of the two groups:compared with the non-severe group,the proportions of dizziness and headache(P=0.030)and chest tightness(P=0.008)were quite different in the severe group;and the levels of aspartate aminotransferase(jP=0.020)、Total bilirubin(P=O.O26)and creatine kinase isoenzyme(P=0.008)were significantly increased;and the platelet count(P=0.017)and albumin(P<0.001)levels were significantly decreased.Multivariate logistic regression analysis showed that decreased platelet count(OR:0.911,P=0.030)、reduced albumin(OR:0.570,P=0.003)and increased creatine kinase isoenzyme(OR:1.153,P=0.025)were risk indicators related to severe scrub typhus.Conclusion The clinical symptoms of patients with scrub typhus are various,physical examination can often find eschar or ulcer,skin rash and lymphadenopathy;the decreased of eosinophil count(or 0)and elevation of ALT and AST which are found in laboratory tests are useful for disease diagnosis.Decreased platelet count、Hypoalbuminemia and increased creatine kinase isoenzymes are risk factors for severe scrub typhus,this result is of great significance for the early identification of severe patients.