摘要
目的:总结分析肾综合征出血热的临床特征及影像学表现,提高其早期诊断符合率。方法:回顾性分析78例确诊为肾综合征出血热患者的临床及影像资料,总结其临床及影像学特征。结果:肾综合征出血热患者最常见的临床表现为发热(72/78,92.31%)、少尿或无尿(65/78,83.33%)、呕吐腹泻(63/78,80.77%)、头痛腰痛腹痛(47/78,60.26%)、颜面部及颈胸部充血(49/78,62.82%),其他表现包括部分患者伴有全身散在出血点(22/78,28.21%)、颜面部或下肢水肿(19/78,24.36%)甚至休克(6/78,7.69%)。实验室检查最常见异常为白细胞升高、血小板降低、转氨酶升高、尿素氮及肌酐升高、凝血时间延长、尿蛋白阳性;部分患者伴有淀粉酶升高、肌钙蛋白升高等。58例(74.36%)患者肾综合征出血热病毒IgM及IgG阳性。胸腹部CT最常见表现为肾肿胀(42/78,53.85%)、肾周筋膜增厚伴渗出(63/78,80.77%)、腹腔积液(56/78,71.79%)、胸腔积液及肺不张(54/78,69.23%),其他表现包括胰腺炎(31/78,39,74%)、心包积液(22/78,28.21%)、两肺感染(18/78,23.08%)、肝密度减低(11/78,14.10%)及肾包膜下出血(9/78,11.54%)等;头颅MRI表现为垂体信号异常(2/78,2.56%)、脑出血(1/78,1.28%)等。结论:肾综合征出血热患者最主要的临床特征为多器官损害,其临床特征复杂,诊断需结合患者的症状体征、实验室检查及影像学表现。通过影像学检查可了解病情的严重程度,以制定正确的治疗方案,为治疗赢得宝贵时间。
Objective:To analyze the clinical and imaging features of hemorrhagic fever with renal syndrome(HFRS).Methods:The clinical and imaging data of 78 HFRS patients were retrospectively reviewed.Results:The most common clinical manifestations of HFRS were fever(72/78,92.31%),oliguria or anuria(65/78,83.33%),vomiting and diarrhea(63/78,80.77%),headache,low back pain and abdominal pain(47/78,60.26%),facial congestion,neck and chest congestion(49/78,62.82%).Other manifestations included scattered bleeding spots throughout the body(22/78,28.21%),facial or lower limb edema(19/78,24.36%),and even shock(6/78,7.69%).The most common abnormalities in laboratory tests were leukocyte elevation,platelet reduction,transaminase elevation,urea nitrogen and creatinine elevation,prolonged coagulation time,and urinary protein positivity;amylase elevation and troponin elevation were accompanied in some patients.58 patients(74.36%)were positive for HFRS virus IgM and IgG.The most common chest and abdomen CT manifestations were kidney swelling(42/78,53.85%),perirenal fascia thickening with exudation(63/78,80.77%),peritoneal effusion(56/78,71.79%),pleural effusion and atelectasis(54/78,69.23%).Other manifestations included pancreatitis(31/78,39,74%),pericardial effusion(22/78,28.21%),bilateral pulmonary infection(18/78,23.08%),decreased liver density(11/78,14.10%)and renal subcapsular hemorrhage(9/78,11.54%),etc.Cranial MR showed abnormal signal in pituitary gland(2/78,2.56%)and brain hemorrhage(1/78,1.28%).Conclusion:HFRS tends to show multiple organ damages with complex clinical characteristics.Imaging may be valuable for disease severity assessment and guiding clinical decision.
作者
刘畅
毛国群
杨光钊
刘希胜
孙娜娜
LIU Chang;MAO Guo-qun;YANG Guang-zhao(Department of Radiology,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China)
出处
《放射学实践》
CSCD
北大核心
2021年第2期206-210,共5页
Radiologic Practice
关键词
肾综合征出血热
多器官损害
临床特征
体层摄影术
X线计算机
磁共振成像
Hemorrhagic fever with renal syndrome
Multiple organ damage
Clinical features
Tomography,X-ray computed
Magnetic resonance imaging
