71例恙虫病合并肺炎临床观察

Clinical Observation on 71 Cases of Tsutsugamushi Disease Complicated with Pneumonia

目的对恙虫病合并肺炎患者进行临床观察,为本病早期诊断及治疗提供依据和参考。方法选取我院内科2020年1月至2021年6月收治的71例恙虫病合并肺炎患者为研究对象,回顾性调研患者临床资料,归纳总结患者的临床特征、实验室指标特征、肺影像学特征及预后情况。结果71例患者入院时均有发热症状,以入院体温≥39℃者占比较多,为84.51%。66例患者入院时皮肤有特征性焦痂或溃疡,主要见于会阴、腋窝、肛周、外生殖器、腹股沟等部位,另有肺干湿性啰音68例,以轻咳和咳少量白色黏液痰为主的咳嗽咳痰患者68例,是恙虫病合并肺炎的主要症状体征。嗜酸性粒细胞减少、红细胞沉降率升高、C反应蛋白升高与丙氨酸转氨酶升高是恙虫病合并肺炎患者主要实验室指标特征,占比均在70%以上,另有部分白细胞计数异常、血小板计数降低、血尿素氮升高病例,占比在30%左右。胸部CT平扫主要影像学表现为纵隔淋巴结肿大(35.21%),腋窝淋巴结肿大(39.44%),胸腔积液(28.17%),磨玻璃影(14.08%)。经强力霉素积极抗感染辅以对症处理及支持治疗,患者体温恢复正常,呼吸道症状消失,治愈率为100%。结论恙虫病合并肺炎的临床表现多样,以发热、焦痂或溃疡、肺干湿性啰音、咳嗽咳痰为主,实验室检查可见明显炎性反应,胸部CT检查多表现为肺纹理增粗、肺部阴影、淋巴结肿大、胸腔积液等,强力霉素是有效可行的治疗药物,早期诊断、及时治疗对改善患者预后具有积极作用。

Objective To observe the clinical features of tsutsugamushi disease complicated with pneumonia,and provide basis and reference for early diagnosis and treatment of the disease.Methods 71 patients with tsutsugamushi disease complicated with pneumonia admitted in our hospital from January 2020 to June 2021 were selected as the research objects,and the clinical data of patients were retrospectively investigated,and the clinical characteristics,laboratory index characteristics,pulmonary imaging characteristics and prognosis of patients were summarized.Results 71 patients had fever symptoms when they were admitted to the hospital,and the majority of them had a temperature≥39℃(84.51%).66 patients had characteristic eschar or ulcer on their skin when they were admitted to the hospital,which was mainly found in the perineum,armpit,perianal,external genitalia,groin,etc.There were also 68 patients with dry and wet rales of the lung,68 patients with cough and sputum mainly consisting of light cough and a small amount of white mucus sputum,which were the main symptoms and signs of scrub typhus disease complicated with pneumonia.Eosinophilia,elevated erythrocyte sedimentation rate,elevated C-reactive protein and elevated alanine aminotransferase are the main laboratory indicators of tsutsugamushi disease patients with pneumonia,accounting for more than 70%.Some cases with abnormal white blood cell count,decreased platelet count and elevated blood urea nitrogen account for about 30%.The main imaging manifestations of chest CT plain scan were mediastinal lymph node enlargement 35.21%,axillary lymph node enlargement 39.44%,pleural effusion 28.17%,ground glass shadow 14.08%.After doxycycline active anti infection and symptomatic treatment and supportive treatment,the patient's temperature returned to normal,respiratory symptoms disappeared,and the cure rate was 100%.Conclusion Tsutsugamushi disease complicated with pneumonia has various clinical manifestations,mainly including fever,eschar or ulcer,dry and wet rale of lung,cough and expectoration.Laboratory examination shows obvious inflammatory reaction.Chest CT examination mostly shows thickening of lung texture,lung shadow,lymph node enlargement,pleural effusion,etc.Doxycycline is an effective and feasible treatment drug.Early diagnosis and timely treatment have a positive role in improving the prognosis of patients.