甘肃省47例儿童内脏利什曼病病例临床特征及诊疗效果分析

Clinical features and diagnosis and treatment effect in 47 children cases of visceral leishmaniasis in Gansu Province

回顾性分析2011年5月至2021年12月在兰州大学第二医院确诊的47例儿童(<15岁)内脏利什曼病病例的临床特征及诊疗特点。结果显示,47例患儿均有流行区旅居史;其中,男童26例(占55.3%),多于女童(21例,占44.7%);3岁以下婴幼儿居多,为28例(占59.6%);夏季发病人数最多,17例(占36.2%),其余月份均有散发。临床表现以反复发热(44例,占93.6%)、贫血(45例,占95.7%)、腹胀(35例,占74.5%)为主,伴脾肿大(38例,占80.9%)、肝肿大(34例,占72.3%)及淋巴结肿大(16例,占34.0%)。实验室检查以贫血(45例,占95.7%)、全血细胞减少(31例,占66.0%)、炎性指标升高(43例,占91.5%)为主。47例患儿均行rK39免疫层析试条检测,其中46例(占97.9%)利什曼原虫抗体阳性;38例患儿行骨髓穿刺物涂片检查,其中23例(占60.5%)发现利杜体。共45例患儿接受锑剂治疗,其中36例经锑剂标准治疗(葡萄糖酸锑钠总量150~200 mg/kg,分6 d静脉滴注)后治愈,5例患儿追加3~6日治疗后好转,锑剂治疗的有效率为91.1%;1例死亡,3例复发,复发率为6.7%。提示对有流行区旅居史的、符合内脏利什曼病临床表现的患儿,应尽早行rK39免疫层析试条检测,结合骨髓穿刺检查,早诊断并予以规范锑剂治疗;锑剂标准治疗无效时,建议追加锑剂治疗天数。

A retrospective analysis was performed on 47 children(<15 years old)with visceral leishmaniasis diagnosed in the Lanzhou University Second Hospital from May 2011 to December 2021 clinical features and diagnostic features.The results showed that all 47 cases had a history of living in endemic areas.Among them,26 cases were boys(55.3%),which is than 21 cases of girls(44.7%).Most cases were of infants under 3 years old(59.6%).The number of cases was the highest in summer,with 17 cases(36.2%),and sporadic in the rest of the month.The main clinical manifestations were recurrent fever(44 cases,93.6%),anemia(45 cases,95.7%),abdominal distension(35 cases,74.5%),accompanied by spleen enlargement(38 cases,80.9%),liver enlargement(34 cases,72.3%)and lymph node enlargement(16 cases,34.0%).The main laboratory tests were anemia(45 cases,95.7%),pancytopenia(31 cases,66.0%)and elevated inflammatory index(43 cases,91.5%).The rK39 immunochromatographic test was performed for 47 cases,of which 46 cases(97.9%)were positive for Leishmania antibody.Thirty-eight patients underwent bone marrow biopsy smear examination,of which 23(60.5%)found Leishmania-Donovan bodies.A total of 45 cases were treated with antimony,of which 36 cases were cured after standard antimony treatment(150-200 mg/kg antimony sodium gluconate,divided into 6 days).Significant improvement was seen in 5 cases after 3-6 days of additional treatment,and the effective rate of antimony was 91.1%.One patient died,and three patients had relapse,with a recurrence rate of 6.7%.It is suggested that children with a history of living in endemic areas and meeting the clinical manifestations of visceral leishmaniasis should be diagnosed as early as possible by rK39 immunotomographic test,combined with bone marrow smear examination and standard antimony treatment.When standard antimony treatment is ineffective,additional antimony treatment days are recommended.