61例恙虫病患者临床及血液学特征分析

发布时间：2018-05-28 19:30

本文选题：恙虫病 + 稽留热　；参考：《大理学院》2014年硕士论文

【摘要】：目的回顾性分析大理学院附属医院2006年8月～2013年10月收治的61例成人恙虫病完整病例的临床资料，对近期来大理地区恙虫病的临床特征、血液学特征及骨髓象情况进行分析，与以往的文献资料进行对比，总结本地区的恙虫病临床及血液学特点，以更好的指导临床诊治。方法⑴收集大理学院附属医院2006年8月～2013年10月收治的成人恙虫病患者临床资料及同期在本院体检的健康人的实验室检查资料，对恙虫病患者的临床特征、血常规、骨髓象、部分血清生化指标、肥达外斐试验、腹部彩超等内容进行统计分析。 ⑵将符合纳入标准的61例恙虫病患者作为病例组，分别编号为1号～61号。将101例健康人作为对照组，分别编号为62号～162号。 (3)统计学处理：①.病例组:一般情况（症状、体征）、肥达外斐试验结果、血清钙离子浓度、嗜酸性粒细胞计数绝对值、骨髓细胞学检查结果，采用率、构成比进行统计描述。②.使用SPSS Statistics17.0统计软件对两组调查对象的数据进行分析,所有的p值均为双向，当p值0.05时认为有显著性差异。③.两组调查对象:采用方差分析判断年龄构成是否一致，采用卡方检验判断性别构成是否一致。④.采用二分类非条件Logistic回归判断:恙虫病是否会导致患者的1).白细胞计数较健康人升高或降低；2).血红蛋白较健康人降低；3).血小板计数较健康人降低；4).丙氨酸氨基转移酶较健康人升高；5).天冬氨酸氨基转移酶较健康人升高；6).白蛋白较健康人降低；7).尿素较健康人升高；8).肌酐较健康人升高；9).尿酸较健康人升高。结果⑴一般情况61例患者中男性19例，女性42例，男女发病比例1:2.2,发病年龄19～84岁，中位年龄为55岁。入院时体温正常3例（4.9%），发热58例(95.1%)，高热42例(68.9%)。呈稽留热型48例（82.76%），弛张热型9例（15.52%），不规则热1例（1.72%）。特异性焦痂或溃疡61例（100%）,头痛34例（55.7%），腹痛33例（54.0%）,腹部压痛33例（54.0%），皮疹3例（4.9%），出现合并症37例（60.66%），以肺部感染为主（64.9%）），其他包括急性胆囊炎、急性胃肠炎、继发性血小板减少症、低钾血症等，出现两个及两个以上器官或系统损害13例（33.3%），其中3例为多器官功能衰竭。给予有效的抗病原体治疗24～48小时后51例体温高峰下降，7例无下降。 ⑵肥达外斐检测结果：进行肥达外斐试验检测53例，阳性反应者13例，阳性率为24.5%，其中外斐试验反应阳性者10例，变形杆菌OXK反应阳性者6例，，阳性率为11.3%,其中凝集效价≥1:160者2例，占3.8%，效价为1:80者4例，占7.5%。4例变形杆菌OX19阳性，效价1:80～1:160。3例同时出现OX19及OXK阳性。2例肥达反应阳性。1例同时出现抗体O及OX19阳性。 ⑶二分类非条件Logistic回归结果：恙虫病与血小板计数、丙氨酸氨基转移酶、天冬氨酸氨基转移酶的数量发生异常的风险呈显著的相关关系（P≤0.01）。恙虫病患者发生血小板计数减少的风险是健康人发生血小板计数减少的223.718（OR=223.718，95CIs=16.092-3110.139）；发生丙氨酸氨基转移酶升高的风险是健康人发生丙氨酸氨基转移酶升高的33.356倍（OR=33.356，95CIs=2.347-474.062）；发生天冬氨酸氨基转移酶升高的风险是健康人发生天冬氨酸氨基转移酶升高的152.285倍（OR=152.285，95CIs=7.910-2931.644）。 ⑷嗜酸性粒细胞计数绝对值、血清钾离子浓度、血清钙离子浓度：49例恙虫病患者的嗜酸性粒细胞计数绝对值检测值主要分布在0～0.04×10^9/L,32例检测结果0.02×10^9/L，占63.27%。25例检测结果为0，占51%。61例患者中，22例患者血清钾离子浓度检测结果3.5mmol/L，占36.06%。61例患者的血清钙离子浓度检测值主要分布在1.49～2.32mmol/L之间，48例检测结果2.15mmol/L，占78.68%。 ⑸骨髓细胞学检查结果：10例恙虫病患者骨髓有核细胞增生程度表现为活跃及明显活跃。粒细胞系统增生比例60%者7例，60%者3例。粒细胞均以中幼粒及以下的细胞为主，5例粒细胞出现中毒颗粒及空泡变性。红细胞系统增生比例占15%～25%7例，3例比例25%。在1.5cm×3cm血膜的血膜上见巨核细胞数3～1000个，其中，7个1例，7～35个2例，35个7例。巨核细胞增生以颗粒型及裸核型巨核细胞为主，产板型巨核细胞数量少。血小板分布正常4例，分布减低6例。出现异型淋巴细胞比例增高3例，比例分别为5%,9%,6%.出现噬血现象2例，噬血细胞比例分别为2%、2.5%。此10例恙虫病患者对应的外周血象中，2例血小板计数正常，8例血小板计数减少。出现血小板计数减少病例相应骨髓穿刺细胞学检查结果示，5例巨核系细胞增生并成熟障碍，2例骨髓象正常,1例巨核细胞增生减低，6例血小板分布减低，2例血小板分布正常。相应的腹部彩超检查结果示，脾脏肿大5例，正常3例。另外，此10例患者的外周血象检查结果中，白细胞计数10×10^9/L2例，4×10^9/L4例，正常4例；血红蛋白110g/L3例，正常7例。行嗜酸性粒细胞计数检测6例，0.02×10^9/L者3例，正常3例。结论本研究通过回顾性分析近期大理地区61例恙虫病患者临床及实验室检查资料，得出以下结论：①大理地区恙虫病骨髓象特点表现为粒系、红系、巨核系细胞增生活跃，成熟粒细胞中出现中毒颗粒，巨核系细胞增生伴成熟障碍，可出现异型淋巴细胞比例增高及噬血现象；②恙虫病患者发热的热型以稽留热型为主，与传统文献报道的弛张热型不符；③占54%的患者出现腹痛症状；④外斐试验阳性率低；⑤占78.68%的患者合并低钙血症；⑥恙虫病导致患者血小板计数降低、丙氨酸氨基转移酶升高、天冬氨酸氨基转移酶升高；⑦嗜酸性粒细胞计数为0时对恙虫病的诊断有一定提示意义。
[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.
【学位授予单位】：大理学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R513.2

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