本文選題：恙蟲病 + 稽留熱��； 參考：《大理學(xué)院》2014年碩士論文

【摘要】：目的回顧性分析大理學(xué)院附屬醫(yī)院2006年8月～2013年10月收治的61例成人恙蟲病完整病例的臨床資料，對(duì)近期來(lái)大理地區(qū)恙蟲病的臨床特征、血液學(xué)特征及骨髓象情況進(jìn)行分析，與以往的文獻(xiàn)資料進(jìn)行對(duì)比，總結(jié)本地區(qū)的恙蟲病臨床及血液學(xué)特點(diǎn)，以更好的指導(dǎo)臨床診治。 方法⑴收集大理學(xué)院附屬醫(yī)院2006年8月～2013年10月收治的成人恙蟲病患者臨床資料及同期在本院體檢的健康人的實(shí)驗(yàn)室檢查資料，對(duì)恙蟲病患者的臨床特征、血常規(guī)、骨髓象、部分血清生化指標(biāo)、肥達(dá)外斐試驗(yàn)、腹部彩超等內(nèi)容進(jìn)行統(tǒng)計(jì)分析。 ⑵將符合納入標(biāo)準(zhǔn)的61例恙蟲病患者作為病例組，分別編號(hào)為1號(hào)～61號(hào)。將101例健康人作為對(duì)照組，分別編號(hào)為62號(hào)～162號(hào)。 (3)統(tǒng)計(jì)學(xué)處理：①.病例組:一般情況（癥狀、體征）、肥達(dá)外斐試驗(yàn)結(jié)果、血清鈣離子濃度、嗜酸性粒細(xì)胞計(jì)數(shù)絕對(duì)值、骨髓細(xì)胞學(xué)檢查結(jié)果，采用率、構(gòu)成比進(jìn)行統(tǒng)計(jì)描述。②.使用SPSS Statistics17.0統(tǒng)計(jì)軟件對(duì)兩組調(diào)查對(duì)象的數(shù)據(jù)進(jìn)行分析,所有的p值均為雙向，當(dāng)p值0.05時(shí)認(rèn)為有顯著性差異。③.兩組調(diào)查對(duì)象:采用方差分析判斷年齡構(gòu)成是否一致，采用卡方檢驗(yàn)判斷性別構(gòu)成是否一致。④.采用二分類非條件Logistic回歸判斷:恙蟲病是否會(huì)導(dǎo)致患者的1).白細(xì)胞計(jì)數(shù)較健康人升高或降低；2).血紅蛋白較健康人降低；3).血小板計(jì)數(shù)較健康人降低；4).丙氨酸氨基轉(zhuǎn)移酶較健康人升高；5).天冬氨酸氨基轉(zhuǎn)移酶較健康人升高；6).白蛋白較健康人降低；7).尿素較健康人升高；8).肌酐較健康人升高；9).尿酸較健康人升高。 結(jié)果⑴一般情況61例患者中男性19例，女性42例，男女發(fā)病比例1:2.2,發(fā)病年齡19～84歲，中位年齡為55歲。入院時(shí)體溫正常3例（4.9%），發(fā)熱58例(95.1%)，高熱42例(68.9%)。呈稽留熱型48例（82.76%），弛張熱型9例（15.52%），不規(guī)則熱1例（1.72%）。特異性焦痂或潰瘍61例（100%）,頭痛34例（55.7%），腹痛33例（54.0%）,腹部壓痛33例（54.0%），皮疹3例（4.9%），出現(xiàn)合并癥37例（60.66%），以肺部感染為主（64.9%）），其他包括急性膽囊炎、急性胃腸炎、繼發(fā)性血小板減少癥、低鉀血癥等，出現(xiàn)兩個(gè)及兩個(gè)以上器官或系統(tǒng)損害13例（33.3%），其中3例為多器官功能衰竭。給予有效的抗病原體治療24～48小時(shí)后51例體溫高峰下降，7例無(wú)下降。 ⑵肥達(dá)外斐檢測(cè)結(jié)果：進(jìn)行肥達(dá)外斐試驗(yàn)檢測(cè)53例，陽(yáng)性反應(yīng)者13例，陽(yáng)性率為24.5%，其中外斐試驗(yàn)反應(yīng)陽(yáng)性者10例，變形桿菌OXK反應(yīng)陽(yáng)性者6例，，陽(yáng)性率為11.3%,其中凝集效價(jià)≥1:160者2例，占3.8%，效價(jià)為1:80者4例，占7.5%。4例變形桿菌OX19陽(yáng)性，效價(jià)1:80～1:160。3例同時(shí)出現(xiàn)OX19及OXK陽(yáng)性。2例肥達(dá)反應(yīng)陽(yáng)性。1例同時(shí)出現(xiàn)抗體O及OX19陽(yáng)性。 ⑶二分類非條件Logistic回歸結(jié)果：恙蟲病與血小板計(jì)數(shù)、丙氨酸氨基轉(zhuǎn)移酶、天冬氨酸氨基轉(zhuǎn)移酶的數(shù)量發(fā)生異常的風(fēng)險(xiǎn)呈顯著的相關(guān)關(guān)系（P≤0.01）。恙蟲病患者發(fā)生血小板計(jì)數(shù)減少的風(fēng)險(xiǎn)是健康人發(fā)生血小板計(jì)數(shù)減少的223.718（OR=223.718，95CIs=16.092-3110.139）；發(fā)生丙氨酸氨基轉(zhuǎn)移酶升高的風(fēng)險(xiǎn)是健康人發(fā)生丙氨酸氨基轉(zhuǎn)移酶升高的33.356倍（OR=33.356，95CIs=2.347-474.062）；發(fā)生天冬氨酸氨基轉(zhuǎn)移酶升高的風(fēng)險(xiǎn)是健康人發(fā)生天冬氨酸氨基轉(zhuǎn)移酶升高的152.285倍（OR=152.285，95CIs=7.910-2931.644）。 ⑷嗜酸性粒細(xì)胞計(jì)數(shù)絕對(duì)值、血清鉀離子濃度、血清鈣離子濃度：49例恙蟲病患者的嗜酸性粒細(xì)胞計(jì)數(shù)絕對(duì)值檢測(cè)值主要分布在0～0.04×10^9/L,32例檢測(cè)結(jié)果0.02×10^9/L，占63.27%。25例檢測(cè)結(jié)果為0，占51%。61例患者中，22例患者血清鉀離子濃度檢測(cè)結(jié)果3.5mmol/L，占36.06%。61例患者的血清鈣離子濃度檢測(cè)值主要分布在1.49～2.32mmol/L之間，48例檢測(cè)結(jié)果2.15mmol/L，占78.68%。 ⑸骨髓細(xì)胞學(xué)檢查結(jié)果：10例恙蟲病患者骨髓有核細(xì)胞增生程度表現(xiàn)為活躍及明顯活躍。粒細(xì)胞系統(tǒng)增生比例60%者7例，60%者3例。粒細(xì)胞均以中幼粒及以下的細(xì)胞為主，5例粒細(xì)胞出現(xiàn)中毒顆粒及空泡變性。紅細(xì)胞系統(tǒng)增生比例占15%～25%7例，3例比例25%。在1.5cm×3cm血膜的血膜上見巨核細(xì)胞數(shù)3～1000個(gè)，其中，7個(gè)1例，7～35個(gè)2例，35個(gè)7例。巨核細(xì)胞增生以顆粒型及裸核型巨核細(xì)胞為主，產(chǎn)板型巨核細(xì)胞數(shù)量少。血小板分布正常4例，分布減低6例。出現(xiàn)異型淋巴細(xì)胞比例增高3例，比例分別為5%,9%,6%.出現(xiàn)噬血現(xiàn)象2例，噬血細(xì)胞比例分別為2%、2.5%。此10例恙蟲病患者對(duì)應(yīng)的外周血象中，2例血小板計(jì)數(shù)正常，8例血小板計(jì)數(shù)減少。出現(xiàn)血小板計(jì)數(shù)減少病例相應(yīng)骨髓穿刺細(xì)胞學(xué)檢查結(jié)果示，5例巨核系細(xì)胞增生并成熟障礙，2例骨髓象正常,1例巨核細(xì)胞增生減低，6例血小板分布減低，2例血小板分布正常。相應(yīng)的腹部彩超檢查結(jié)果示，脾臟腫大5例，正常3例。另外，此10例患者的外周血象檢查結(jié)果中，白細(xì)胞計(jì)數(shù)10×10^9/L2例，4×10^9/L4例，正常4例；血紅蛋白110g/L3例，正常7例。行嗜酸性粒細(xì)胞計(jì)數(shù)檢測(cè)6例，0.02×10^9/L者3例，正常3例。 結(jié)論本研究通過(guò)回顧性分析近期大理地區(qū)61例恙蟲病患者臨床及實(shí)驗(yàn)室檢查資料，得出以下結(jié)論：①大理地區(qū)恙蟲病骨髓象特點(diǎn)表現(xiàn)為粒系、紅系、巨核系細(xì)胞增生活躍，成熟粒細(xì)胞中出現(xiàn)中毒顆粒，巨核系細(xì)胞增生伴成熟障礙，可出現(xiàn)異型淋巴細(xì)胞比例增高及噬血現(xiàn)象；②恙蟲病患者發(fā)熱的熱型以稽留熱型為主，與傳統(tǒng)文獻(xiàn)報(bào)道的弛張熱型不符；③占54%的患者出現(xiàn)腹痛癥狀；④外斐試驗(yàn)陽(yáng)性率低；⑤占78.68%的患者合并低鈣血癥；⑥恙蟲病導(dǎo)致患者血小板計(jì)數(shù)降低、丙氨酸氨基轉(zhuǎn)移酶升高、天冬氨酸氨基轉(zhuǎn)移酶升高；⑦嗜酸性粒細(xì)胞計(jì)數(shù)為0時(shí)對(duì)恙蟲病的診斷有一定提示意義。
[Abstract]:Objective to analyze the clinical data of 61 complete cases of adult tsutsugamushi disease in the Affiliated Hospital of Dali University from August 2006 to October 2013, and to analyze the clinical features, hematological features and bone marrow images of tsutsugamushi disease in Dali area in recent years, and to compare with the previous literature and summarize the clinical and blood of tsutsugamushi disease in the region. The characteristics of the fluid study to better guide the clinical diagnosis and treatment.
Methods the clinical data of the patients with tsutsugamushi disease in the Affiliated Hospital of Dali University from August 2006 to October 2013 and the laboratory examination data of healthy people in the medical examination in the same period were collected. The clinical features, blood routine, bone marrow images, some serum biochemical indexes, ffida test, abdominal color Doppler and so on were used for the statistics of the patients with tsutsugamushi disease. Analysis.
(2) 61 cases of tsutsugamushi disease were selected as case groups and were numbered from No. 1 to No. 61. 101 healthy persons were used as control group, numbered from 62 to 162, respectively.
(3) statistical treatment: (1) case group: general situation (symptoms, signs), fat Da test results, serum calcium ion concentration, eosinophil count absolute value, bone marrow cytological examination results, use rate, composition ratio of statistical description. 2. Use SPSS Statistics17.0 statistical software to analyze data of two groups of respondents Some p values were both bi-directional, and there were significant differences when the p value was 0.05. 3. The two groups of subjects: the variance analysis was used to determine whether the age composition was consistent, and the chi square test was used to determine whether the gender composition was consistent. (4) two classification unconditional Logistic regression was used to determine whether tsutsugamushi disease would lead to 1 of the patients. High or lower; 2). Hemoglobin was lower than healthy person; 3). Platelet count was lower than healthy person; 4). Alanine aminotransferase was higher than healthy person; 5). Aspartic aminotransferase was higher than healthy person; 6). Albumin was lower than healthy person; 7). Urea was higher than healthy person; 8). Creatinine was higher than healthy person; 9). Uric acid was healthier. The health is rising.
Results (1) there were 19 males and 42 females in 61 cases, the incidence of male and female was 1:2.2, the age was 19~84 years old and the middle age was 55 years. 3 cases (95.1%), 58 fever (95.1%) and 42 cases (68.9%) were fever and 42 cases (68.9%). 61 cases (100%), 34 cases of headache (55.7%), 33 cases of abdominal pain (54%), 33 cases of abdominal tenderness (54%), 3 cases of rash (4.9%), 37 cases of complication (60.66%), pulmonary infection mainly (64.9%), the other including acute cholecystitis, acute gastroenteritis, secondary hemosis, hypokalemia, etc. Among them, 3 cases were multiple organ failure. After 24~48 hours of effective antifungal therapy, 51 cases had a drop in body temperature and 7 cases did not decrease.
(2) fillda external fig test results: 53 cases were detected by fad test, positive rate was 13, the positive rate was 24.5%, of which 10 cases were positive for external fig test, 6 cases of Proteus OXK positive reaction, the positive rate was 11.3%, including 2 cases of agglutination titer more than 1:160, 4 cases of 1:80, 7.5%.4 cases of Proteus OX19 positive. In cases of 1:80 to 1:160.3, OX19 and OXK positive.2 cases were positive, while.1 positive cases occurred in.1 cases, while antibody O and OX19 were positive.
(3) two classification of non conditional Logistic regression results: the risk of tsutsugamushi disease and platelet count, alanine aminotransferase, and aspartate aminotransferase were significantly associated with the risk of abnormal number (P < 0.01). The risk of thrombocytopenia in tsutsugamushi patients was 223.718 (OR=223.71 8,95CIs=16.092-3110.139); the risk of elevations of alanine aminotransferase is 33.356 times (OR=33.356,95CIs=2.347-474.062) of alanine aminotransferase in healthy people (OR=33.356,95CIs=2.347-474.062); the risk of aspartic aminotransferase increase is 152.285 times as high as that of aspartic aminotransferase in healthy people (OR=152.285,95CIs=7.9 10-2931.644).
The absolute value of eosinophil count, serum potassium ion concentration and serum calcium concentration: the absolute value of eosinophil count in 49 cases of tsutsugamushi disease was mainly distributed in 0 to 0.04 x 10^9/L, 32 cases were 0.02 x 10^9/L, accounting for 0 of the 63.27%.25 cases, and 22 patients were tested for serum potassium ion concentration. The results were 3.5mmol/L, which accounted for 1.49 to 2.32mmol/L of serum calcium concentration in 36.06%.61 patients, and 2.15mmol/L in 48 cases, accounting for 78.68%.
The results of bone marrow cytology showed that 10 cases of tsutsugamushi disease were active and active in the degree of myelocytic proliferation. The proportion of granulocyte system hyperplasia in 7 cases and 60% of 3 cases. The granulocytes were dominated by medium and young granulocytes and 5 cases of granulocyte poisoning particles and vacuoles. The proportion of erythrocyte system hyperplasia accounted for 15% to 25%7. In 3 cases, 3 cases had 3~1000 megakaryocytes on the blood membrane of 1.5cm x 3cm blood membrane, of which 7 1 cases, 7~35 2 cases and 35 7 cases. Megakaryocyte proliferation was mainly granulated and naked karyotype megakaryocyte, the number of plate type megakaryocytes was less. The distribution of platelets in 4 cases, and 6 cases of distribution reduction, compared with 3 cases of abnormal type lymphocytes. The cases were 5%, 9%, 6%., 2 cases of hemophagocytic phenomenon, 2% of hemophagocytic cells, 2.5%. in the corresponding peripheral hemogram of 10 cases of tsutsugamushi disease, 2 cases of normal platelets count and 8 cases of platelet count decrease. The result showed that the platelet count decreased correspondingly with the result of bone marrow aspiration cytology examination, 5 megakaryocytosis and maturation disorder, 2 Cases with normal bone marrow, 1 cases of megakaryocyte hyperplasia, 6 cases of platelet distribution and 2 cases of normal platelets, 5 cases of splenomegaly and 3 normal cases. In addition, in the 10 cases of peripheral blood examination, leukocyte count 10 * 10^9/ L2 cases, 4 x 10^9/L4 cases, 4 normal cases, hemoglobin 110g/L3 cases, Normal 7 cases. Eosinophil count was detected in 6 cases, 0.02 x 10^9/L in 3 cases, and normal in 3 cases.
Conclusion by retrospective analysis of the clinical and laboratory examination data of 61 cases of tsutsugamsugamushi disease in Dali, the following conclusions are drawn: (1) the characteristics of scrub typhus in Dali region are granulocytic, red, megakaryocytic cells proliferate, toxic particles appear in mature granulocytes, and megakaryocytic cell proliferation with maturation disorder can occur. The proportion of heteromorphic lymphocytes increased and hemophagy was increased; (2) the heat type of fever in tsutsugamushi patients was mainly in the type of the resia heat type, which was not consistent with the traditional literature reported. (3) 54% of the patients had abdominal pain symptoms; (4) the positive rate of the external fig test was low; (5) the patients with 78.68% were associated with hypocalcemia; (6) tsutsugamushi disease caused the platelet count The elevations of alanine aminotransferase and aspartate aminotransferase increased, and when the eosinophil count was 0, it was significant for the diagnosis of tsutsugamushi disease.
【學(xué)位授予單位】：大理學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R513.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳生曉;沈宏峰;張力軍;許晨曦;孫忠明;;我國(guó)南海某群島320例恙蟲病并發(fā)多臟器損害的臨床分析[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2007年22期

2 董霖;張瑞平;;妊娠合并恙蟲病19例臨床分析[J];中國(guó)婦產(chǎn)科臨床雜志;2008年01期

3 羅清逢,高孝慈,龍堯,徐軍發(fā);恙蟲病患者血清TNF-α、IL-8和P-sel水平的檢測(cè)及其臨床意義[J];廣東醫(yī)學(xué)院學(xué)報(bào);2000年03期

4 李勇逵,楊彩虹;恙蟲病合并低蛋白血癥、水電解質(zhì)紊亂100例分析[J];國(guó)際醫(yī)藥衛(wèi)生導(dǎo)報(bào);2004年22期

5 曹欣;吳躍;洪文昕;;84例恙蟲病臨床特點(diǎn)分析[J];傳染病信息;2013年01期

6 張平,段文帥,王柱芳;恙蟲病致全身多臟器損害46例臨床分析[J];臨床薈萃;2001年22期

7 吳澤生;;恙蟲病并急性胰腺炎1例[J];臨床薈萃;2006年23期

8 張祿;張宏麗;戈國(guó)亮;陳琳;;恙蟲病并血小板減少82例[J];臨床薈萃;2008年07期

9 王坤;陳長(zhǎng)華;吳方;;恙蟲病并發(fā)肝功能損害62例臨床分析[J];淮海醫(yī)藥;2012年04期

10 匡時(shí)權(quán),尹春霞;恙蟲病致腎功能不全3例診治分析[J];臨床薈萃;2004年22期

本文編號(hào)：1947908