摘要
【目的】探讨喀什地区黑热病患者的流行病学和临床特征,以提高诊疗水平。【方法】对2013年1月至2023年12月喀什地区第一人民医院收治的71例黑热病患者的临床资料进行回顾性分析。【结果】71例黑热病患者中,0岁~5岁患者最多,占52.11%(37/71),男女比例为0.92:1,患者发病多在冬春季。临床特征主要表现为发热、乏力、食欲下降以及脾脏、肝脏增大。实验室检查主要为三系减少,血清白球比倒置、转氨酶升高、C反应蛋白及降钙素原升高。抗rK39抗体检测的阳性率为100%(23/23),骨髓镜检的阳性率为91.38%(53/58),肝组织病原宏基因组高通量测序(mNGS)检出杜氏利什曼原虫1例。常见的并发症为感染中毒性肝炎49.30%(35/71)、心肌炎29.56%(21/71)、支气管肺炎23.94%(17/71)。【结论】来自黑热病流行地区,出现长期不规则发热伴脾脏增大患者,血细胞减少、白球比倒置,应考虑黑热病可能,可予完善骨髓涂片镜检、抗rK39抗体检测,mNGS提供了诊断的新方法。
【Objective】To explore the epidemiology and clinical characteristics of kala-azar patients in Kashgar region,so as to improve the diagnosis and treatment.【Methods】A retrospective analysis was conducted on the clinical data of 71 kala-azar patients admitted to the First People’s Hospital of Kashgar Region between January 2013 and December 2023.【Results】Among the 71 patients,the majority were aged 0-5 years(52.11%,37/71),with a male-to-female ratio of 0.92:1.Most cases occurred in winter and spring.Common clinical manifestations included fever,fatigue,decreased appetite,splenomegaly and hepatomegaly.Laboratory investigations mainly found pancytopenia,reversed albumin-to-globulin ratio,elevated transaminases,and increased C-reactive protein and procalcitonin.The positive rates of anti-rK39 antibody detection and bone marrow microscopy were 100%(23/23)and 91.38%(53/58),respectively.Metagenomics next-generation sequencing(mNGS)of liver tissue identified Leishmania donovani in one case.The common complications were infectious toxic hepatitis 49.30%(35/71),myocarditis 29.56%(21/71),and bronchopneumonia 23.94%(17/71).【Conclusions】Potential kala-azar should be taken into consideration for patients from the endemic areas with long-term irregular fever accompanied by splenomegaly,hemocytopenia,and reversed albumin-to-globulin ratio.Bone marrow smear microscopy and anti-rK 39 antibody detection are recommended for the diagnosis,and mNGS provides a novel diagnostic solution.
作者
李娇玲
祖丽皮亚·莫明
买买提艾力·吐尔逊
高洁
刘城源
崇雨田
朱建芸
LI Jiaoling;Zulipiya MOMING;Maimaitiaili TUERXUN;GAO Jie;LIU Chengyuan;CHONG Yutian;ZHU Jianyun(Department of Infectious Diseases,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Infectious Diseases,The First People’s Hospital of Kashgar Prefecture,Kashgar 844000,China)
出处
《中山大学学报(医学科学版)》
北大核心
2025年第4期708-713,共6页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省援疆农村科技(特派员)项目(KTPYJ2023027)。
