热带病与寄生虫学

热带病与寄生虫学 ›› 2023, Vol. 21 ›› Issue (6): 321-325.doi: 10.3969/j.issn.1672-2302.2023.06.004

• 恙虫病防控专题 • 上一篇    下一篇

恙虫病临床特征及重症恙虫病的早期诊断

李翔(), 马仲序, 李国忠, 姜建杰, 付旭文, 张乐()   

  1. 云南省传染性疾病临床医学中心，昆明市第三人民医院，云南昆明 650041
  • 收稿日期:2023-01-03 出版日期:2023-12-20 发布日期:2024-01-12
  • 通信作者: 张乐，E-mail: 9035643@qq.com
  • 作者简介:李翔，男，硕士，主治医师，研究方向：传染病影像学。E-mail: 15887138804@163.com
  • 基金资助:
    云南省临床医学重点专科建设项目;昆明市卫生科技人才培养项目-百工程[2021-SW（省）-13]

Clinical features of scrub typhus and early diagnosis of severe scrub typhus

LI Xiang(), MA Zhongxu, LI Guozhong, JIANG Jianjie, FU Xuwen, ZHANG Le()   

  1. Clinical Medical Center for Infectious Diseases in Yunnan Province, Kunming Third People's Hospital, Kunming 650041, Yunnan Province, China
  • Received:2023-01-03 Online:2023-12-20 Published:2024-01-12
  • Contact: ZHANG Le, E-mail: 9035643@qq.com

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摘要：

目的 了解恙虫病临床特征，探讨重症恙虫病诊断的早期临床指征。方法 收集昆明市第三人民医院2017年1月至2021年12月恙虫病确诊患者的临床资料、胸部CT影像学及实验室检查结果；将恙虫病患者分为非重症恙虫病组（简称非重症组）与重症恙虫病组（简称重症组），利用logistic回归法分析重症恙虫病的早期临床指征。结果 研究共纳入恙虫病患者181例，其中非重症组104例，重症组77例。所有患者均发现皮肤焦痂，最常见于躯干，占47.5%（86/181）。患者均出现发热，其他临床表现为头痛、咳嗽、腹痛、肌肉酸痛和呼吸困难。胸部CT影像表明，所有患者胸腔积液的发生率为49.7%（90/181），重症组和非重症组发生率分别为67.5%（52/77）和36.5%（38/104），差异有统计学意义（χ2=17.001，P<0.05）。实验室检查中，重症组外周血中性粒细胞绝对值、谷草转氨酶、C反应蛋白、降钙素原、乳酸脱氢酶、D-二聚体及白细胞介素-6水平高于非重症组，外周血血小板计数低于非重症组，差异均有统计学意义（Z=2.858、-3.870、-5.937、-6.546、-4.153、-4.802、-5.119、-5.039，P均<0.05）。回归分析结果表明，血清谷草转氨酶、降钙素原、白细胞介素-6升高以及存在胸腔积液与重症恙虫病发生有相关性；受试者工作特征曲线（receiver operating characteristic curve, ROC）曲线下面积为0.839，其敏感度为62.3%，特异度为96.2%。结论 患者出现发热伴随皮肤焦痂应考虑恙虫病的可能，血清谷草转氨酶、降钙素原、白细胞介素-6升高和胸部CT显示胸腔积液可作为考虑恙虫病发展为重症的早期指标，应予以关注，对有重症倾向的患者及早诊治，以期降低病死率。

关键词: 恙虫病, 立克次体, 临床特征, 重症病例, 早期诊断

Abstract:

Objective To understand the clinical manifestation of scrub typhus, and explore the early clinical indications for severe scrub typhus. Methods Clinical data, chest CT imaging and laboratory findings were collected from patients diagnosed with scrub typhus from January 2017 to December 2021 in the Kunming Third People's Hospital. Then the cases were divided into non-severe scrub typhus (non-severe group) and severe scrub typhus (severe group). Logistic regression model was used to analyze the clinical manifestation of severe scrub typhus in early stage. Results In total, 181 patients with scrub typhus were included in this study, in whom 104 cases (57.5%) were included in the non-severe group, and 77 (42.5%) in the severe group. All patients developed skin eschar, commonly occurring at the trunk, which accounted for 47.5% (86/181) of all cases. Fever was generally seen in all patients. Other clinical manifestations consisted of headache, cough, abdominal pain, muscle aches, and dyspnea. Chest CT imaging revealed pleural effusion in 49.7% (90/181) of the patients. The incidence of pleural effusion was 67.5% (52/77) in the severe group and 36.5% (38/104) in the non-severe group (χ2=17.001, P<0.05). In laboratory tests, blood neutrophil count, level of aspartate aminotransferase, C-reactive protein, procalcitonin, lactate dehydrogenase, D-dimer and interleukin-6 levels were significantly higher in the severe group than in the non-severe group (Z=2.858, -3.870, -5.937, -6.546, -4.153, -4.802, -5.119, respectively, all P<0.05), and peripheral blood platelet count was significantly lower in the severe group than in the non-severe group (Z=-5.039, P<0.05). The regression analysis showed that elevated levels of aspartate aminotransferase, procalcitonin, interleukin-6 and the presence of pleural effusion were early clinical indicative of severe scrub typhus. The area under receiver operating characteristic curve (ROC) was 0.839, which had a sensitivity of 62.3% and a specificity of 96.2%. Conclusion Patients with fever and skin eschar shall be considered potential scrub typhus, and elevated levels of aspartate aminotransferase, procalcitonin and interleukin-6 as well as pleural effusion demonstrated by CT imaging can be early indicative of severe scrub typhus, and worthy of high attention. Patients with tendency to severe condition should be timely diagnosed and treated in order to reduce the mortality.

Key words: Scrub typhus, Rickettsia, Clinical features, Severe cases, Early diagnosis

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