桂林市某医院30例恙虫病患者临床特征分析

Clinical characteristics of 30 cases of scrub typhus in a hospital in Guilin

目的分析桂林市某医院30例恙虫病病例流行及临床特征。方法回顾性分析2018年11月15日—2021年8月11日桂林医学院第一附属医院收治的恙虫病临床诊断病历资料。结果30例中男性16例、女性14例,以50~65岁居多;阳朔县、灵川县、全州县病例最多;发病时间于7月和9月(12例,40.00%)多见;最常见的症状是发热(93.33%)、焦痂或溃疡(83.33%)和头痛(56.67%);外斐试验检查结果阳性12例。统计分析结果显示,恙虫病合并多器官功能障碍综合征(multiple organ dysfanction syndrome,MODS)患者的重症率、血小板、白蛋白、血肌酐、尿隐血、尿蛋白的异常率明显高于无MODS患者,差异均有统计学意义(χ^(2)=7.778、16.813、5.510、3.998、15.099、4.675,P<0.05);实验室检查结果显示,血小板、红细胞、天门冬氨酸氨基转移酶、血红蛋白、丙氨酸氨基转移酶治疗前后比较差异有统计学意义(t=-6.331、4.567、2.829、4253、2.346,P<0.05)。26例给予多西环素治疗患者中,就诊当日服用多西环素的恙虫病患者较非就诊当日服用的患者住院天数更少,差异有统计学意义(t=-2.727,P<0.05)。结论恙虫病患者以中老年人居多,夏秋季多见,临床表现多样,可累及多脏器损害。因此,应高度重视恙虫病发生MODS的危险因素,尽早明确诊断恙虫病并及时给予对症治疗,控制病情进一步恶化及发生重症或死亡的危险。

Objective To analyze the epidemiological and clinical characteristics of 30 scrub typhus cases in a hospital in Guilin city,Guangxi Zhuang Autonomous Region.Methods The clinical records of 30 cases of scrub typhus admitted to the First Affiliated Hospital of Guilin Medical College between November 15,2018 and August 11,2021 were retrospectively collected and analyzed using t-test andχ^(2)test.Results There were 16 males and 14 females in the 30 cases,and most of them were aged 50-65 years.Most cases occurred in Yangshuo,Lingchuan and Quanzhou counties.The onset time was mainly in July and September(12 cases,40.00%).The most common symptoms were fever(93.33%),eschar or ulcer(83.33%),and headache(56.67%).Twelve cases were tested positive Weil-Felix test.Statistical analysis showed that in patients with multiple organ dysfunction syndrome(MODS),the proportions of severe cases,abnormal albumin level,abnormal serum creatinine level,occult blood in urine,and proteinuria were significantly higher than those in the patients without MODS(χ^(2)=7.778,16.813,5.510,3.998,15.099,4.675,P<O.05).Laboratory test results showed statistically significant differences of platelets,red blood cells,aspartate aminotransferase,hemoglobin,and alanine aminotransferase,levels before and after treatment(t=-6.331,4.567,2.829,4253,2.346,P<0.05).Among the 26 patients treated with doxycycline,the length of hospitalization in the patients taking doxycycline on the day of visit was significantly shorter than that in those not taking doxycycline on theday of visit(t=-2.727,P<0.05).Conclusions Scrub typhus patients are mainly middle-aged and elderly people,mostly occurred in summer and autumn,with various clinical manifestations and may be with multiple organ damage.Therefore,close attention should be paid to the risk factors of MODS in scrub typhus.The diagnosis of scrub typhus should be made as early as possible and symptomatic treatment be provided in time to prevent further deterioration to severe illness or death.