华北地区5所医院炭疽病例系列研究

A series case study on anthrax cases in five hospitals in North China

目的对华北地区5所医院的住院炭疽病例进行系列研究,分享治疗皮肤炭疽和肺炭疽的临床经验。方法纳入2018年8月至2022年3月于华北地区5所医院住院的40例炭疽患者,分成轻症组和重症组,收集其临床特征、治疗和预后情况进行分析。本研究为回顾性、多中心、队列研究。统计学方法采用χ^(2)检验、独立样本t检验和曼-惠特尼U检验。结果40例炭疽患者中,重症10例(25.0%),轻症30例(75.0%);皮肤炭疽39例(其中1例继发肺炭疽),肺炭疽1例。重症组畏寒、发热,淋巴结肿大的发生率,以及并发肝功能异常、低蛋白血症的发生率,均高于轻症组,差异均有统计学意义(χ^(2)=5.71、6.54、4.68、9.22,均P<0.05)。重症组外周血白细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞比值、C反应蛋白分别为(11.8±4.9)×10^(9)/L、(9.5±5.1)×10^(9)/L、8.6±7.3、27.9(8.6,167.7)mg/L,分别高于轻症组的(7.5±2.4)×10^(9)/L、(5.0±2.1)×10^(9)/L、3.2±2.3、3.5(1.2,14.7)mg/L,差异均有统计学意义(t=2.66、2.71、2.32,Z=-3.01,均P<0.05);重症组白蛋白为(35.5±8.1)g/L,低于轻症组的(43.7±3.2)g/L,差异有统计学意义(t=-3.13,P=0.011)。重症组皮损最大径>4 cm、多发、大疱、水肿性皮损的发生率高于轻症组,差异有统计学意义(χ^(2)=6.01,P=0.014)。39例皮肤炭疽患者中,28例(71.8%)轻症组患者单用青霉素治疗,9例(23.1%)重症组患者采用青霉素、氧氟沙星、哌拉西林/他唑巴坦联合利奈唑胺、多西环素或克林霉素中的一种进行抗感染治疗。2例肺炭疽患者针对胸腔积液和气胸进行胸腔闭式引流术,并选择2种杀菌剂和1种蛋白质合成抑制剂联合治疗。40例炭疽患者全部治愈出院。结论轻症皮肤炭疽患者可采用青霉素单药治疗,重症皮肤炭疽和肺炭疽患者应采用抗菌药物联合治疗。

ObjectiveTo conduct a series case study on hospitalized anthrax cases in five hospitals in North China,to share clinical experiences in the diagnosis and treatment of cutaneous and pulmonary anthrax.MethodsA retrospective,multicenter cohort study was conducted on the anthrax patients admitted to five hospitals in North China from August 2018 to March 2022.Forty patients were divided into severe and mild groups.The clinical features,treatment and prognosis of the patients were collected and analysed.Statistical evaluations included independent sample t test,Mann-Whitney U test,and chi-square test.ResultsAmong the 40 patients with anthrax,10(25.0%)were severely ill and 30(75.0%)were mildly ill.According to the sites of infection,40 patients were classified as 39 cutaneous anthrax cases(one case had secondary pulmonary anthrax)and one pulmonary anthrax case.The rates of chills and fever,lymphadenopathy,liver dysfunction and hypoalbuminemia in the severe group were all higher than those in the mild group,with statistically significant differences(χ^(2)=5.71,6.54,4.68 and 9.22,respectively,all P<0.05).The peripheral white blood cell count,neutrophil count,neutrophil/lymphocyte ratio and C-reactive protein were(11.8±4.9)×10^(9)/L,(9.5±5.1)×10^(9)/L,8.6±7.3,27.9(8.6,167.7)mg/L,respectively,which were all higher than those in mild disease group((7.5±2.4)×10^(9)/L,(5.0±2.1)×10^(9)/L,3.2±2.3,3.5(1.2,14.7)mg/L),with statistically significant differences(t=2.66,t=2.71,t=2.32 and Z=-3.01,respectively,all P<0.05).The albumin level in the severe group was(35.5±8.1)g/L,which was lower than that of the mild group((43.7±3.2)g/L),and the difference was statistically significant(t=-3.13,P=0.011).The severe cases were more likely to have skin lesions greater than four centimetre in diameter,multiple,vesicular,or edematous,with a significant difference(χ^(2)=6.01,P=0.014).Among 39 patients with cutaneous anthrax,28(71.8%)in the mild group were treated with penicillin alone,and nine(23.1%)in the severe group were treated with penicillin,ofloxacin,piperacillin/tazobactam combined with one of linezolid,doxycycline,or clindamycin for anti-infection treatment.The two patients with pulmonary anthrax were treated with closed thoracic drainage for pleural effusion and pneumothorax,and were treated with two bactericidal and one protein synthesis inhibitor antibiotics.All 40 anthrax patients were cured and discharged from hospital.ConclusionsPatients with mild cutaneous anthrax can generally be treated with single penicillin,and patients with severe cutaneous anthrax and pulmonary anthrax should be treated with combined antibiotics.