恙虫病67例临床特征分析

Clinical characteristics of tsutsugamushi disease: an analysis of 67 cases

回顾分析云南省玉溪市人民医院全科医疗科2020年1月1日至2022年12月30日确诊的67例恙虫病患者的病例资料,包括疾病流行病学、临床特征及实验室检查结果。其中重症患者14例,非重症患者53例。67例患者年龄41~65岁,重症组患者年龄大于非重症组(P<0.05)。男性患者43例(64.18%),农村居住者56例(83.58%)。患者就诊时间集中于夏秋季节,7—10月份共计59例(88.1%)。67例恙虫病患者均出现焦痂或溃疡,其中,22例(32.8%)焦痂或溃疡部位在褶皱部位,18例(26.8%)在躯干部,27例(40.4%)在四肢。重症组全身皮疹、畏寒寒战发生率高于非重症组(均P<0.05),血红蛋白、血小板、白蛋白、尿酸和血清总胆红素水平低于非重症组(均P<0.05),C反应蛋白、降钙素原、丙氨酸转氨酶、天冬氨酸转氨酶、血肌酐、尿素氮、肌酸激酶同工酶、乳酸脱氢酶水平和凝血酶原时间高于非重症组(均P<0.05)。非重症组抗立克次体感染治疗显效率优于重症组(χ^(2)=5.16,P<0.05)。提示全科医生应重视恙虫病的早期识别和诊断,及时对非重症患者行抗立克次体感染治疗,可取得较好治疗效果。

The clinical data of 67 patients with tsutsugamushi disease diagnosed and treated in Department of General Medicine,Yuxi People′s Hospital of Yunnan Province from January 2020 to December 2022 were retrospectively analyzed.Among them,43 were males and 24 were females and most of patients were from rural areas(n=56,83.58%);there were 14 severe cases and 53 non-severe cases,the age of patients ranged from 41 to 65 years,and the average age of severe cases was older than that of non-severe cases.Most of patients were encountered in July to October(n=59,88.1%).All patients presented eschar or ulcer,which were occurred in limbs(n=27,40.4%),body folds(n=22,32.8%)or trunk(n=18,26.8%).The incidence of systemic rash and chills in severe group was higher than that in non-severe group(P<0.05).The levels of Hb,platelet,ALB,uric acid and TBil in severe cases were lower than those in non-severe cases(all P<0.05),while the levels of CRP,PTC,ALT,AST,Scr,Urea nitrogen,CKMB,LDH,and APTT were higher than those in non-severe cases(all P<0.05).The curative effect of anti-rickettsia therapy in non-severe group was better than that in severe group(χ^(2)=5.16,P<0.05).It is suggested that general practitioners should pay attention to tsutsugamushi disease,and early diagnosis and treatment can achieve good therapeutic effect.