猴痘患者41例的临床特征分析

Clinical characteristics of 41 patients with mpox

目的分析总结猴痘患者的临床特征,提高临床医师对重症猴痘的认识,为临床诊治提供依据。方法回顾性分析2023年6月至11月收治于首都医科大学附属北京佑安医院41例猴痘患者的临床特征。根据患者临床表现分为轻症和重症,比较两组患者的实验室检查结果。统计学分析采用曼-惠特尼U检验。结果41例猴痘患者的临床表现主要包括发热、皮疹和淋巴结肿大,5例重症猴痘患者可出现严重合并症,包括细菌性肺炎、Ⅰ型呼吸衰竭、真菌感染、阴茎或肛周干性坏疽、阴茎软组织水肿、肠梗阻、脓毒症休克、肛周脓肿和坏死性筋膜炎。重症猴痘患者的白细胞计数、中性粒细胞计数、C反应蛋白均明显高于轻症组患者[14.60(9.92,24.08)×10^(9)/L比6.41(5.64,8.37)×10^(9)/L,12.43(7.02,21.15)×10^(9)/L比3.35(2.46,5.03)×10^(9)/L,108.20(56.20,124.10)mg/L比16.6(6.25,49.98)mg/L];白蛋白、CD4+T淋巴细胞计数则明显低于轻症组患者[31.80(22.90,35.15)g/L比44.70(42.90,47.40)g/L,24.00(12.00,81.50)/μL比606.00(414.50,767.50)/μL],差异均有统计学意义(U=2.81、3.02、2.98、3.56、3.26,均P<0.01)。结论临床治疗中,如果猴痘患者的白细胞计数和C反应蛋白明显升高,CD4+T淋巴细胞计数明显下降,或出现严重合并症时,需警惕猴痘重症感染。

Objective To analyze and summarize the clinical characteristics of mpox patients,thereby to rise clinicians′awareness of severe mpox and provide a foundation for clinical diagnosis and treatment.Methods The clinical data were retrospectively analyzed in 41 mpox patients treated at the Beijing You′an Hospital,Capital Medical University,from June to November 2023.Patients were categorized into mild and severe cases based on clinical manifestations,and laboratory results of the two groups were compared.Statistical analysis was performed using the Mann-Whitney U test.Results The clinical manifestations of 41 mpox patients mainly included fever,rash and lymphadenopathy.Five patients with severe mpox might develop serious complications,including bacterial pneumonia,typeⅠrespiratory failure,fungal infections,penile or perianal dry gangrene,penile soft tissue edema,intestinal obstruction,septic shock,perianal abscess,and necrotizing fasciitis.Patients with severe mpox had significantly higher white blood cell count(WBC),neutrophil count and C-reactive protein(CRP)level compare to those with mild cases(14.60(9.92,24.08)×10^(9)/L vs 6.41(5.64,8.37)×10^(9)/L,12.43(7.02,21.15)×10^(9)/L vs 3.35(2.46,5.03)×10^(9)/L,108.20(56.20,124.10)mg/L vs 16.6(6.25,49.98)mg/L),while the albumin level and CD4+T lymphocyte count in the severe group were significantly lower compared to the mild cases(31.80(22.90,35.15)g/L vs 44.70(42.90,47.40)g/L,24.00(12.00,81.50)/μL vs 606.00(414.50,767.50)/μL)).All these differences were statistically significant(U=2.81,3.02,2.98,3.56 and 3.26,respectively,all P<0.01).Conclusions In clinical practice,clinicians should be vigilant for the possibility of severe mpox if patients exhibit a significant increase of WBC and CRP,a significant decrease in CD4+T lymphocyte count,or if they develop severe complications.