IR@PKUHSC  > 北京大学第三临床医学院  > 感染疾病科
学科主题传染病学
重症恙虫病的临床特征分析
其他题名Clinical Features of Severe Scrub Typhus Patients
李璐; 张敏; 徐玉辉; 胥婕
关键词丛林斑疹伤寒 降钙素原 临床特征 Scrub typhus Procalcitonin Clinical features
刊名中国全科医学
2015
DOI10.3969/j.issn.1007-9572.2015.23.016
23页:2813-2816
收录类别中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型Journal Article
摘要目的:探讨重症恙虫病的临床特征。方法选择2011年7月—2013年10月在赣州市人民医院住院恙虫病患者66例,根据重症诊断标准将患者分为重症组29例和非重症组37例。比较两组患者的临床表现、实验室检查、影像学检查和治疗及预后等。结果重症组呼吸困难、心悸、下肢水肿、肺部啰音、低血压发生率均高于非重症组(P<0.05)。患者焦痂发生率为97.0%。重症组血小板(PLT)、清蛋白(Alb)水平低于非重症组,血肌酐(Scr)、尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBiL)、肌酸激酶( CK)、肌酸激酶同工酶( CK-MB)、乳酸脱氢酶( LDH)、降钙素原( PCT)水平高于非重症组, ALT/AST比例倒置发生率高于非重症组(P<0.05)。外斐反应OXK多在起病1周内检测,阳性率为14.7%(5/34)。重症组均行胸部X线检查,28例(96.6%)有肺部炎性渗出表现;22例(75.9%)有单侧或双侧胸腔积液。非重症组31例行胸部X线检查,19例(61.3%)有肺部炎性渗出表现;13例(41.9%)有单侧或双侧胸腔积液。重症组肺部炎性渗出、胸腔积液发生率均高于非重症组(P<0.05)。重症组中10例(34.5%)肝大,19例(65.5%)脾大,8例(27.6%)有腹腔积液。非重症组中9例(24.3%)肝大,20例(54.1%)脾大,5例(13.5%)有腹腔积液。两组肝大、脾大、腹腔积液发生率比较,差异均无统计学意义(P>0.05)。确诊后患者使用多西环素或四环素治疗。重症组热退时间为(4.3±2.2) d,高于非重症组的(2.7±1.8) d ( P<0.05)。结论重症患者与非重症患者相比,呼吸困难、心悸、下肢水肿、肺部啰音、低血压发生率、 PLT、 Alb、 Scr、 BUN、 ALT、 AST、 TBiL、 CK、 CK-MB、 LDH、 PCT水平、发生ALT/AST比例倒置等指标有统计学差异,更易出现双肺受累及胸腔积液,热退时间更长。对于有重症倾向的患者应严密监测并积极治疗,以降低病死率。 Objective To identify the clinical features of severe scrub typhus patients . Methods A total of 66 patients with scrub typhus who were admitted into Ganzhou Renmin Hospital from July 2011 to October 2013 were enrolled.According to the diagnostic criterion of severe disease , the patients were divided into two groups: severe group ( n=29) and non -severe group ( n =37).Comparison was made between the two groups in clinical manifestation , laboratory examination, imageology examination, treatment and prognosis.Results Severe group was higher (P <0.05) than non -severe group in the incidence of dyspnea , palpitation , lower limb edema , rale in lung and hypotension .The incidence of eschar was 97.0%.Severe group was lower ( P<0.05 ) in the levels of PLT and Alb and higher ( P<0.05 ) in the levels of Scr , BUN, ALT, AST, TBiL, CK, CK-MB, LDH and PCT than non -severe group.Severe group was also higher ( P<0.05 ) than non-severe group in the incidence of the ratio inversion of ALT /AST.Weil-Felix OXK reaction was tested within one week after onset, with a positive rate of 14.7% (5/34).Through the chest X -ray examination conducted on all subjects in severe group, we noted inflammatory exudation in 28 ( 96.6%) subjects and unilateral or bilateral pleural effusion in 22 ( 75.9%) subjects.Chest X-ray examination was conducted on 31 subjects in non -severe group , by which we noted inflammatory exudation in 19 (61.3%) subjects and change of pleural effusion in 13 (41.9%) subjects.Severe group was higher ( P<0.05) than non-severe group in the incidence of inflammatory exudation and pleural effusion .In severe group, 10 (34.5%) subjects had hepatomegaly , 19 ( 65.5%) subjects had splenauxe , 8 ( 27.6%) subjects had seroperitoneum .In non -severe group, 9 ( 24.3%) subjects had hepatomegaly , 20 ( 54.1%) subjects had splenauxe , 5 ( 13.5%) subjects had seroperitoneum.The two groups had no significant difference (P>0.05) in hepatomegaly, splenauxe and seroperitoneum.After diagnosis, the subjects were treated with doxycycline and tetracycline .The time need for abating fever was (4.3 ±2.2) d for severe group, longer (P<0.05) than that of non-severe group which was (2.7 ±1.8) d.Conclusion Severe scrub typhus patients are significantly different from non -severe scrub typhus patients in the incidence of dyspnea , palpitation , lower limb edema, rale in lung and hypotension , in the levels of PLT, Alb, Scr, BUN, ALT, AST, TBiL, CK, CK-MB, LDH and PCT and in the incidence of the ratio reversion of ALT/AST.Severe scrub typhus patients are more likely to have double lung involvement , pleural effusion and longer time need for abating fever .Severe scrub typhus patients should be closely monitored and treated actively in order to reduce case fatality rate .
语种中文
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文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/70320
Collection北京大学第三临床医学院_感染疾病科
作者单位1.北京大学第三医院感染疾病科,北京市,100191
2.赣州市人民医院呼吸科
Recommended Citation
GB/T 7714
李璐,张敏,徐玉辉,等. 重症恙虫病的临床特征分析[J]. 中国全科医学,2015(23):2813-2816.
APA 李璐,张敏,徐玉辉,&胥婕.(2015).重症恙虫病的临床特征分析.中国全科医学(23),2813-2816.
MLA 李璐,et al."重症恙虫病的临床特征分析".中国全科医学 .23(2015):2813-2816.
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