CAJ | 학술논문

目的总结我国发现的人粒细胞无形体病(HGA)暴发流行的临床特点,为HGA的防治积累临床经验.方法对2006年11月发生在皖南医学院弋矶山医院的10例HGA患者的流行病学特点、临床特征及诊治经验进行回顾性分析.结果 10例HGA患者中,除首例发病前有蜱叮咬史外,余9例均有与首发病例密切接触史.潜伏期为6～13 d.除畏寒、发热、头痛,全身酸痛外,多数患者有相对缓脉、表情淡漠及多脏器功能损伤.实验室检查显示,WBC和PLT减少,部分患者出现异型淋巴细胞、蛋白尿、管形尿以及ALT、AST、心肌酶谱升高和部分活化凝血酶原时间延长等.1例患者末梢血HGA包涵体检测阳性.血清学检测结果符合美国疾病预防控制中心(CDC)的HGA诊断标准.首发病例死亡,第2代9例患者均痊愈出院,其中治疗延迟、年龄大、使用免疫抑制剂的患者病情加重.结论要重视HGA在我国的流行.诊断须重视流行病学资料,HGA传播途径多样,须严密隔离,防止暴发流行.
목적 총결아국발현적인립세포무형체병(HGA)폭발류행적림상특점,위HGA적방치적루림상경험.방법 대2006년11월발생재환남의학원익기산의원적10례HGA환자적류행병학특점、림상특정급진치경험진행회고성분석.결과 10례HGA환자중,제수례발병전유비정교사외,여9례균유여수발병례밀절접촉사.잠복기위6～13 d.제외한、발열、두통,전신산통외,다수환자유상대완맥、표정담막급다장기공능손상.실험실검사현시,WBC화PLT감소,부분환자출현이형림파세포、단백뇨、관형뇨이급ALT、AST、심기매보승고화부분활화응혈매원시간연장등.1례환자말소혈HGA포함체검측양성.혈청학검측결과부합미국질병예방공제중심(CDC)적HGA진단표준.수발병례사망,제2대9례환자균전유출원,기중치료연지、년령대、사용면역억제제적환자병정가중.결론 요중시HGA재아국적류행.진단수중시류행병학자료,HGA전파도경다양,수엄밀격리,방지폭발류행.
Objective To summarize the clinical characteristics of the outbreak of the human granulocytic anapasmosis (HGA) in China for sharing and accumulating clinical experience to prevent and treat the disease. Methods Epidemiological characteristics, clinical features and experiences in diagnosis and treatment of ten HGA patients were reviewed and analyzed. All these cases were admitted in Yijishan Hospital of Wannan Medical College during November 2006. Results Besides the index case showed the history of tick bite, the other nine patients had no evidence of tick bite but close contact with the index patient. The latency varied from 6 to 13 days. Besides chilling, fever, headache and body aches, the common symptoms included relative pulse ease, indifferent expression, and multiple organ dysfunctions. The common laboratory abnormalities included thrombocytopenia and leucocytopenia. Some patients showed heterotypic lymphocyte, proteinuria, urine tube, abnormal alanine amiotransferase (ALT), aspartate transaminase (AST) and myocardial enzymes as well as extended activated partial thromboplastin time (APTT). Inclusion bodies were detected in the peripheral blood samples from one patient. Serological test results were consistent with the diagnosis standard of HGA developed by the United States Centers for Disease Control and Prevention (CDC). The index patient died. The other nine of second generation patients were all cured as a result of early detection and strict isolation for medical treatment. Elder, delayed initiation of treatment and concomitant use of immunosuppressive drugs were all factors contributing to exacerbation. Conclusions Attention should be paid to the prevalence of HGA in China. As the transmission routes of HGA are diverse, epidemiological data are very important for diagnosis. Patients with HGA must be strictly isolated to prevent the outbreak.