湖南省某大型综合医院近30年111例疟疾临床资料分析

发布时间：2018-04-20 20:01

本文选题：疟疾 + 临床研究　；参考：《中南大学》2014年硕士论文

【摘要】：目的：通过回顾性分析湖南省某大型综合医院近30年的疟疾临床资料,以了解疟疾的流行病学变迁及其临床表现、实验室检查、病原学、治疗四个方面的变化,旨在以新的认识和理念指导当前疟疾临床诊治实践,提高疟疾的诊治水平,并为当地完善新形势下的疟疾防控策略提供有价值的参考。方法：1.收集某大型综合医院1984-2013年的疟疾临床资料。 2.比较近30年三个时段疟疾的流行病学变迁。 3.比较境内外病例临床表现、实验室检查、病原学、治疗四个方面的变化。 4.统计学方法：计量资料采用两独立样本的t检验、Wilcoxon检验,计数资料采用卡方检验。结果：1.共收集111份疟疾病例。 2.1984年-1993年组共有14例,境外病例占14.3%(2/14)；1994年-2003年组共有29例,境外病例占17.2%(5/29)；2004年-2013年组共有68例,境外病例占97.1%(66/68)。2004年-2013年组境外病例所占比例显著高于1984年-1993年组和1994年-2003年组,差异有统计学意义,P0.001。 3.疟原虫分型明确的有80例。1984年-1993年组有14例,其中间日疟占78.6%(11/14),恶性疟占21.4%(3/14)；1994年-2003年组有20例,其中间日疟占55.0%(11/20),恶性疟占45.0%(9/20)；2004年-2013年组有46例,其中间日疟占15.2%(7/46),恶性疟占69.6%(32/46),混合感染占15.2%(7/46)。三组病例的虫种构成比比较差异有统计学意义,P0.001。 4.境内病例共38例,境外病例共73例。在临床表现中,境外病例组间歇热、大汗发生率显著低于境内病例组(P0.01),境外病例组寒战发生率显著低于境内病例组(P0.001),而境外病例组酱油色尿、少尿、黄疸、神志改变发生率均显著高于境内病例组(P0.05)。 5.实验室检查中,境外病例组白细胞计数显著高于境内病例组(P0.01),而境外病例组血小板计数显著低于境内病例组(P0.05)；境外病例组白蛋白显著低于境内病例组(P0.001),境外病例组总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶均显著高于境内病例组(P0.001)；境外病例组尿素氮、肌酐均高于境内病例组(P0.05)。 6.血片检出率和骨髓片检出率比较差异无统计学意义。 7.境外病例中恶性疟和混合感染所占比例显著高于境内,差异有统计学意义,P0.001。8.在治疗上,以青蒿素类药物为主,境外病例的退热时间和住院时间与境内相比差异无统计学意义。结论：近十年来湖南省疟疾境外输入性病例显著增多,临床表现不典型、重症病例增多,其病原学分类以恶性疟原虫为主。虽然目前疟疾病例在诸多方面较前有所改变,但是临床常用抗疟药物仍然有效。
[Abstract]:Objective: to analyze retrospectively the clinical data of malaria in a large general hospital in Hunan Province in recent 30 years, in order to understand the changes of malaria epidemiology and its clinical manifestations, laboratory examination, etiology and treatment. The aim of this paper is to guide the current clinical practice of malaria diagnosis and treatment, to improve the level of malaria diagnosis and treatment, and to provide a valuable reference for the local improvement of malaria control strategy under the new situation. Method 1: 1. The clinical data of malaria in a large general hospital from 1984 to 2013 were collected. 2. To compare the epidemiological changes of malaria in three periods in the last 30 years. 3. The changes of clinical manifestation, laboratory examination, etiology and treatment were compared. 4. Statistical method: two independent samples of t test and Wilcoxon test were used to measure the data and chi-square test was used to measure the data. The result is 1: 1. A total of 111 malaria cases were collected. 2. In the 1984-1993 group, there were 14 cases, with foreign cases accounting for 14.33 / 14 / 14; in the 1994-2003 group, there were 29 cases and there were 17. 2 / 29 cases abroad; in the 2004-2013 group, there were 68 cases, and the overseas cases accounted for 97. 1 / 66 / 68. The proportion of overseas cases in the 2004-2013 group was significantly higher than that in the 1984-1993 and 1994-2003 groups. The difference was statistically significant (P 0.001). 3. In the 1984-1993 group, there were 14 cases of Plasmodium falciparum, which accounted for 78.6% / 14%, and falciparum malaria accounted for 21.440% / 14%; in the 1994-2003 group, there were 20 cases, with 55.0% / 20% malaria and 45.0% / 20% falciparum malaria; and 46 cases in the 2004-2013 group. The proportion of Plasmodium falciparum malaria is 15. 2% of 46%, falciparum malaria is 69. 6% 32 / 46, and mixed infection is 15. 2% of 46%. There was significant difference in the proportion of insect species in the three groups (P 0.001). 4. There were 38 cases in China and 73 cases abroad. In the clinical manifestations, the incidence of intermittent fever and sweating in the overseas case group was significantly lower than that in the domestic case group (P 0.01), the incidence of shivering in the overseas case group was significantly lower than that in the domestic case group (P 0.001), while the soy sauce color urine, oliguria and jaundice in the overseas case group were significantly lower than those in the domestic case group. The incidence of mental changes was significantly higher than that of patients in China (P 0.05). 5. In laboratory examination, the white blood cell count in the overseas case group was significantly higher than that in the domestic case group, while the platelet count in the overseas case group was significantly lower than that in the domestic case group, while the albumin in the overseas case group was significantly lower than that in the domestic case group, and the total bilirubin in the overseas case group was significantly lower than that in the domestic case group. Direct bilirubin, alanine aminotransferase and alanine aminotransferase were significantly higher than those in domestic case group (P 0.001), and urea nitrogen and creatinine in overseas case group were higher than that in domestic case group (P 0.05). 6. There was no significant difference between the detection rate of blood smear and that of bone marrow film. 7. The proportion of falciparum malaria and mixed infection in overseas cases was significantly higher than that in China, and the difference was statistically significant (P 0.001.8). In treatment, artemisinin was the main drug, and the time of antipyretic and hospital stay was not significantly different from that in China. Conclusion: in the last ten years, the imported malaria cases in Hunan Province increased significantly, the clinical manifestations were atypical and the severe cases increased. The main pathogenic classification of malaria was Plasmodium falciparum. Although malaria cases have changed in many ways, antimalarial drugs are still effective.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R531.3

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