CAJ | 학술논문

目的：探讨儿童黑热病的流行病学及临床特征特点，为减少误诊误治提供依据。方法对西安市儿童医院1998至2012年收治的23例儿童黑热病临床和实验室资料进行回顾性分析。结果23例患者均有流行区居住史；各月均有发病，以5至9月居多，占全年发病的73．9％（17/23）；男性多于女性，年龄以6岁以下发病者较多，占发病数的86．96％（20/23）；从发病至确诊时间在4个月内的占95．6％（22/23），病程长短与误诊时间有关；主要临床表现为长期不规则发热、进行性贫血和脾肿大，以白细胞为主的全血细胞减少及血浆球蛋白增高。骨髓涂片均检出利什曼原虫，锑剂治疗效果显著。结论儿童黑热病受累脏器多，临床表现虽无特异性，对于长期发热、脾脏肿大和全血细胞减少，特别是来自疫区或在疫区有居住史，在普通抗感染治疗无效的情况下，须考虑到此病。尽早行骨髓穿刺实验室检查，是避免漏诊、误诊的关键，葡萄糖酸锑钠仍然是首选药物，治疗效果显著。
목적：탐토인동흑열병적류행병학급림상특정특점，위감소오진오치제공의거。방법대서안시인동의원1998지2012년수치적23례인동흑열병림상화실험실자료진행회고성분석。결과23례환자균유류행구거주사；각월균유발병，이5지9월거다，점전년발병적73．9％（17/23）；남성다우녀성，년령이6세이하발병자교다，점발병수적86．96％（20/23）；종발병지학진시간재4개월내적점95．6％（22/23），병정장단여오진시간유관；주요림상표현위장기불규칙발열、진행성빈혈화비종대，이백세포위주적전혈세포감소급혈장구단백증고。골수도편균검출리십만원충，제제치료효과현저。결론인동흑열병수루장기다，림상표현수무특이성，대우장기발열、비장종대화전혈세포감소，특별시래자역구혹재역구유거주사，재보통항감염치료무효적정황하，수고필도차병。진조행골수천자실험실검사，시피면루진、오진적관건，포도당산제납잉연시수선약물，치료효과현저。
Objective To explore the epidemiological and clinical characteristics of pediatric kala -azar aiming to provide a reasonable basis for reducing clinical misdiagnosis and mistherapy .Methods Retrospective analysis was carried out on clinical and laboratory data of 23 children with pediatric kala-azar who were admitted in Xi’an Children’s Hospital from 1998 to 2012.Results All of 23 children had the history of living in epidemic areas .Individual occurrences of the disease covered every month of the year , most of which were in the period of May to September, accounting for 73.9%(17/23) of the annual total cases .More cases were found in male population , particularly in those who were under 6 years, accounting for 86.96%(20/23) of all the patients .The time lasting from onset of symptoms to diagnosis of the disease shorter than 4 months accounted for 95.6% (22/23) of all the patients, and the course of disease varied depending on the delay due to misdiagnose.The major clinical manifestations included long term irregular fever , progressive anemia, splenomegaly, pancytopenia ( significantly reduced white blood cells ) and increased level of plasma globulin .And leishmania was observed in bone marrow smears, for which antimonial agents were used with significant therapeutic effects .Conclusion Pediatric kala-azar causes multi-organ involvement without specific clinical manifestations .The children with fever for long term , splenomegaly and pancytopenia , especially those who come from or live in epidemic areas , should be diagnosed with the disease in case of no responses to conventional anti -infective therapy .Performing bone marrow aspiration in laboratory tests as early as possible is the key to avoid missed diagnosis and misdiagnosis .And sodium antimony gluconate is still considered as the first drug for this disease with significant therapeutic effects .