摘要
目的 分析江西地区恙虫病患者的临床特征及预后。方法 回顾性分析南昌大学第二附属医院2012年1月—2020年12月住院的恙虫病患者临床资料。按严重程度进行急性生理与慢性健康评估(APACHEⅡ)评分分为两组,比较两组病例的临床特征、治疗及预后情况,采用二元logistic回归分析恙虫病重症组独立危险因素。结果 74例恙虫病患者以中年(59.46%)和老年(35.14%)为主,中、老年患者病情重症化比较差异有统计学意义(χ2=5.923,P=0.015)。农民和林业工人分别占77.03%和16.22%,81.08%有感染接触史,43.24%就诊前使用过抗生素,发病时间集中于夏季(48.65%)和秋季(32.43%),发病地集中于抚州市(43.24%)和宜春市(22.97%)。临床表现均有特征性焦痂,以发热(95.95%)、头痛(41.89%)、淋巴结肿大(56.76%)、肝脾肿大(47.30%)为主。所有患者嗜酸粒细胞均降低,血小板下降(54.05%)、白蛋白降低(94.59%)、肝转氨酶升高(91.89%)、白细胞水平正常(59.46%)、血肌酐升高(21.62%)。重症恙虫病的显著危险因素为林业工人、肺部感染、尿蛋白升高、退热时间长、血肌酐、误诊,优势比(OR)分别为12.913、3.600、6.600、3.440、1.079、134.923(均P<0.05)。结论 江西地区恙虫病患者主要集中在抚州、宜春等地,多为夏秋农忙两季的中老年林业工人,临床上以高热、特征性焦痂、血管外渗表现突出,实验室检查可见白细胞正常或降低、白蛋白及嗜酸粒细胞显著降低,常出现中毒性肝炎、肺部感染,如早期未能及时诊断,易出现重症化。
Objective To analyze the clinical characteristics and outcomes of 74 cases of scrub typhus in Jiangxi area.Methods The clinical data of patients with scrub typhus treated in the Second Affiliated Hospital of Nanchang University from January 2012 to December 2020 were analyzed retrospectively. The patients were assigned to two groups based on the acute physiology and chronic health evaluation(APACHE II) score to compare the clinical features, treatment and outcome between groups. Binary logistic regression was used to analyze the independent risk factors for severe scrub typhus. Results Most of the 74patients with scrub typhus were middle-aged(59.46%) or elderly(35.14%). The elderly patients were associated with significantly higher severity of disease than the middle-aged patients(χ2=5.923, P = 0.015). Farmers and forestry workers accounted for 77.03%and 16.22% of the patients, respectively. Majority(81.08%) of the patients had a history of exposure and 43.24% had used antibiotics before. Most of the cases ocurred in summer(48.65%) and autumn(32.43%). Most of the cases were found in Fuzhou(43.24%) and Yichun(22.97%). Characteristic eschar was found in all cases. The clinical manifestation included fever(95.95%), headache(41.89%),lymphadenopathy(56.76%), and hepatosplenomeqaly(47.30%). Eosinophils decreased in all cases. Platelets decreased in 54.05% of the cases. Serum albumin decreased in 94.59% of the cases. Liver transaminases increased in 91.89% of the cases. Serum creatinine increased in 21.62% of the cases. Forestry workers [odds ratio(OR), 12.913], pulmonary infection(OR, 3.600), elevated urinary protein(OR, 6.600), longer time to defervescence(OR, 3.440), serum creatinine(OR, 1.079) and misdiagnosis(OR, 134.923) were the significant risk factors of severe scrub typhus(all P < 0.05). Conclusions The cases of scrub typhus in Jiangxi area are mainly found in Fuzhou and Yichun. Most of the patients are middle-aged and elderly forestry workers who are busy in summer and autumn. The scrub typhus is characterized by high fever, characteristic eschar, and vascular extravasation. Laboratory tests showed normal or decreased white blood cell count, significantly decreased albumin and eosinophils. The patients may be complicated with toxic hepatitis and pulmonary infection and progressed to severe condition in case of misdiagnosis.
作者
金堤
宋志英
吴玉婵
艾茂兴
蓝玉
宋淑芬
孙水林
JIN Di;SONG Zhiying;WU Yuchan;AI Maoxing;LAN Yu;SONG Shufen;SUN Shuilin(Department of Infectious Diseases,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2023年第1期34-39,共6页
Chinese Journal of Infection and Chemotherapy
基金
江西省教育厅科学技术重点研究项目(GJJ190031)。
关键词
恙虫病
流行病学
临床特征
预后
scrub typhus
epidemiology
clinical characteristics
outcome
