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目的:分析中山大学孙逸仙纪念医院急诊病区2013年9月至2016年9月收治的恙虫病病例的临床特征,为恙虫病的早期诊治和提高疗效提供临床依据。方法:对2013年9月至2016年9月收治的20例恙虫病患者的流行病学资料、临床表现、实验室检查、并发症、误诊率、治疗和转归情况进行回顾性分析。结果:高发于夏秋季,以中壮年、农民发病居多,发病前均有草木丛林接触史。发热是恙虫病最常见的症状(100%),同时伴有头痛、关节酸痛,咳嗽、咳痰,流涕、鼻塞、咽痛,肌肉疼痛,腹泻等。焦痂或溃疡为其最特异的体征(70%),同时伴有皮疹,肝、脾、淋巴结肿大。嗜酸性粒细胞百分比降低为其最重要血常规特征(95%);降钙素原(PCT)升高(80%)为其重要的诊断指标;外斐试验OXk凝集效价阳性(65%)为其特异的免疫学诊断指标。肝功能损害为其最常见并发症(85%),以及肺炎、胸腔积液、肾脏损害、心脏损害、凝血功能障碍等。该病首诊误诊率为高达75%。氯霉素或多西环素治疗效果良好,治愈率为100%。结论:恙虫病的临床表现复杂多样,并发症多,易误诊。对于长时间不明原因发热的患者,要详细询问病史和体格检查,警惕本病的可能,做到早诊断、早治疗。
Objective: To analyze the clinical features of patients with tsutsugamushi disease admitted to Sun Yat-sen Memorial Hospital Emergency Department of Sun Yat-sen University from September 2013 to September 2016, and to provide a clinical basis for the early diagnosis and treatment of tsutsugamushi disease. Methods: The epidemiological data, clinical manifestations, laboratory tests, complications, misdiagnosis rate, treatment and prognosis of 20 tsutsugamushi patients admitted from September 2013 to September 2016 were analyzed retrospectively. Results: High incidence in summer and autumn, with middle-aged, the majority of farmers incidence, before the onset of exposure to the history of the vegetation. Fever is the most common symptom of tsutsugamushi disease (100%), accompanied by headache, joint pain, cough, sputum, runny nose, stuffy nose, sore throat, muscle pain, diarrhea and the like. Eschar or ulcer is its most specific sign (70%), accompanied by rash, liver, spleen and lymph nodes. Eosinophil percentage decreased to 95% of its most important blood routine; Elevated procalcitonin (PCT) (80%) was an important diagnostic indicator; For its specific immunological diagnostic indicators. Liver damage is its most common complication (85%), as well as pneumonia, pleural effusion, kidney damage, heart damage, coagulation disorders and the like. The first diagnosis of the disease misdiagnosis rate as high as 75%. Chloramphenicol or doxycycline treatment is good, the cure rate was 100%. Conclusion: The clinical manifestations of scrub typhus are complex and diverse, with many complications and are easily misdiagnosed. For a long time unexplained fever patients, to ask history and physical examination in detail, be alert to the possibility of this disease, so early diagnosis and early treatment.