CAJ | 학술논문

目的：探讨广东省中山地区临床诊断为恙虫病患者的临床和流行病学特征，为早期诊断及防治提供依据。方法对198例恙虫病从流行病学、主要临床表现、实验室及影像学检查、治疗等方面进行分析。结果中山地区恙虫病发病例数逐年上升，发病时间主要集中在5~10月份(91.4%)，发病年龄以40~70岁年龄段最多(66.7%)，职业构成以农民居多(31.8%)，大多数(92.9%)患者有草地等野外活动史，常见表现为发热(100%)，焦痂或溃疡(93.9%)，实验室检查变形杆菌外斐凝集反应均阴性(100%)，多数患者出现肝功能损害为丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)升高(95%以上)及白蛋白(ALB)减少(80.3%)，显示肾损害尿蛋白和尿红细胞(53.0%)，炎症反应指标降钙素原(PCT)升高(81.6%)以及嗜酸性粒细胞(EO)计数为0占62.1%，胸部 X 光片提示肺损害的肺部渗出性病变或肺膜炎改变(51.0%)，合并两个或以上器官损害达85.4%，多器官功能障碍综合征(MODS)为8.6%。首诊确诊率为68.2%，病死率1.5%。结论恙虫病临床表现复杂多样，常合并多器官损害，并发症多，容易误诊，因此提高认识，早期诊治和加强高危人群健康教育，有利于改善预后和预防控制恙虫病的发生及流行。
목적：탐토광동성중산지구림상진단위양충병환자적림상화류행병학특정，위조기진단급방치제공의거。방법대198례양충병종류행병학、주요림상표현、실험실급영상학검사、치료등방면진행분석。결과중산지구양충병발병례수축년상승，발병시간주요집중재5~10월빈(91.4%)，발병년령이40~70세년령단최다(66.7%)，직업구성이농민거다(31.8%)，대다수(92.9%)환자유초지등야외활동사，상견표현위발열(100%)，초가혹궤양(93.9%)，실험실검사변형간균외비응집반응균음성(100%)，다수환자출현간공능손해위병안산전안매(ALT)、천동안산전안매(AST)、선감탈안매(ADA)、유산탈경매(LDH)승고(95%이상)급백단백(ALB)감소(80.3%)，현시신손해뇨단백화뇨홍세포(53.0%)，염증반응지표강개소원(PCT)승고(81.6%)이급기산성립세포(EO)계수위0점62.1%，흉부 X 광편제시폐손해적폐부삼출성병변혹폐막염개변(51.0%)，합병량개혹이상기관손해체85.4%，다기관공능장애종합정(MODS)위8.6%。수진학진솔위68.2%，병사솔1.5%。결론양충병림상표현복잡다양，상합병다기관손해，병발증다，용역오진，인차제고인식，조기진치화가강고위인군건강교육，유리우개선예후화예방공제양충병적발생급류행。
Objective To explore the clinical and epidemiologic characteristics of scrub typhus in Zhongshan area for evidence for early diagnosis and treatment.Methods A total of 1 98 patients with scrub typhus were analyzed from various aspects, including epidemiologic characteristics, clinical manifestations, labaratory and imageology examinations,and therapeutics.Results The incidence of scrub typhus was increasing year by year and the disease occurred frequently between May and Octorber (91.4%).Majority of patients were farmers (31.8%)and their main onset age ranged from 40 to 70 years old (66.7%).Most of patients had history of contacting grassland (92.9%) showing symptoms of fever (100%),eschar or ulcer (93.9%).The OXk antigen agglutination reaction of bacillus proteus was negative in all cases.In laboratory examination,the levels of ALT,AST,ADA and LDH were increasing (>95%),however,the level of ALB was reducing (80.3% );the levels of PCT (81.6% ),urine protein and erythrocyte (53.0%)were increasing;the level of EO count 0 accounted for 62.1%.Change in pulmonary damage accounted for 5 1.0% by chest X ray.Scrub typhus patients with two or more organ damage accounted for 85.4%,and scrub typhus patients with MODS accounted for 8.6%.The first diagnosis rate was 68.2% and the mortality rate 1.5%.Conclusion The clinical characteristics of scrub typhus are complex,often accmopanied with multiple organ damage and complications,so the disease is likely misdiagnosed.It is important to early diagnose,treat and strengthen health education for high risk population, it is beneficial to improve prognosis and prevent the occurrence and epidemicity of scrub typhus.