内脏利什曼病死亡病例的临床分析
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摘要
目的了解内脏利什曼病死亡病例的临床特点及实验室指标变化特征。方法分析北京友谊医院2013年1月—2018年6月4例内脏利什曼病死亡患者的临床资料,比较患者实验室指标的差异。结果 4例内脏利什曼病患者的病程3～12个月,患者均出现了多脏器的损伤,其中3例肝、脾大,2例出现中枢神经系统的损伤。4例患者利什曼原虫IgG抗体为阳性,骨髓涂片中均找到了利杜体。4例患者外周血常规的三系明显降低,清蛋白明显降低,球蛋白升高;4例患者的血清钠离子含量低于135 mmol/L。结论内脏利什曼病患者出现病程长,多脏器损伤,累及中枢神经系统,外周血常规三系显著降低,低蛋白血症,以及低钠血症均提示预后差,病死率高。
Objective To understand the clinical characteristics and changes in laboratory indicators of patients died of visceral leishmaniasis(VL).Methods Clinical data of 4 patients died of VL in Beijing Friendship Hospital from January 2013 to June 2018 were analyzed,differences in laboratory indicators were compared.Results Disease course of 4 cases of VL ranged from3 to 12 months,all patients had multiple organ damage,including 3 cases with hepatomegaly and splenomegaly,2 cases with central nervous system damage.IgG antibodies of leishmania were positive in 4 patients,Leishman-Donovan body was found in bone marrow smears.Routine peripheral blood test results in 4 patients decreased significantly,albumin decreased significantly and globulin increased;level of serum sodium ion in 4 patients was lower than 135 mmol/L.Conclusion Long disease course,multiple organ damage,involvement of central nervous system,significant reducing in peripheral blood routine test results,hypoproteinemia,and hyponatremia in patients with VL all indicate poor prognosis and high mortality.
Objective To understand the clinical characteristics and changes in laboratory indicators of patients died of visceral leishmaniasis(VL).Methods Clinical data of 4 patients died of VL in Beijing Friendship Hospital from January 2013 to June 2018 were analyzed,differences in laboratory indicators were compared.Results Disease course of 4 cases of VL ranged from3 to 12 months,all patients had multiple organ damage,including 3 cases with hepatomegaly and splenomegaly,2 cases with central nervous system damage.IgG antibodies of leishmania were positive in 4 patients,Leishman-Donovan body was found in bone marrow smears.Routine peripheral blood test results in 4 patients decreased significantly,albumin decreased significantly and globulin increased;level of serum sodium ion in 4 patients was lower than 135 mmol/L.Conclusion Long disease course,multiple organ damage,involvement of central nervous system,significant reducing in peripheral blood routine test results,hypoproteinemia,and hyponatremia in patients with VL all indicate poor prognosis and high mortality.
引文
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[17]Daher EF,Soares DS,Filho SL,et al.Hyponatremia and risk factors for death in human visceral leishmaniasis:new insights from a cross-sectional study in Brazil[J].BMC Infect Dis,2017,17(1):168.
[2]Lun ZR,Wu MS,Chen YF,et al.Visceral leishmaniasis in China:an endemic disease under control[J].Clin Microbiol Rev,2015,28(4):987-1004.
[3]Silva Junior GB,Barros EJ,Daher Ede F.Kidney involvement in leishmaniasis-a review[J].Braz J Infect Dis,2014,18(4):434-440.
[4]何芳.儿童黑热病46例临床分析[J].临床儿科杂志,2017,35(3):191-194.
[5]Georgiadou SP,Stefos A,Spanakos G,et al.Current clinical,laboratory,and treatment outcome characteristics of visceral leishmaniasis:results from a seven-year retrospective study in Greece[J].Int J Infect Dis,2015,34:46-50.
[6]苏桂华,李修萍.黑热病31例误诊原因分析[J].临床误诊误治,2010,23(10):959-960.
[7]徐俊梅,邹洋.儿童黑热病的诊治及分析[J].中国医刊,2015,50(11):108-110.
[8]吴红卫,李书武,胡丹,等.黑热病流行病学及临床特征分析[J].湖南师范大学学报(医学版),2013,10(3):88-89,93.
[9]Petersen CA,Greenlee MH.Neurologic manifestations of leishmania spp.infection[J].J Neuroparasitology,2011,2,pii:N110401.
[10]Prasad LS,Sen S.Migration of Leishmania donovani amastigotes in the cerebrospinal fluid[J].Am J Trop Med Hyg,1996,55(6):652-654.
[11]Diniz LM,Duani H,Freitas CR,et al.Neurological involvement in visceral leishmaniasis:case report[J].Rev Soc Bras Med Trop,2010,43(6):743-745.
[12]高芹,刘焱斌,钟册俊,等.137例内脏利什曼病患者临床分析[J].中国寄生虫学与寄生虫病杂志,2013,31(2):135-137.
[13]刘真真,唐光敏,叶慧,等.黑热病79例临床诊治回顾性分析[J].临床荟萃,2015,30(3):316-318.
[14]Belo VS,Struchiner CJ,Barbosa DS,et al.Risk factors for adverse prognosis and death in American visceral leishmaniasis:A Meta-analysis[J].PLoS Negl Trop Dis,2014,8(7):e2982.
[15]Mour2o MV,Toledo A Jr,Gomes LI,et al.Parasite load and risk factors for poor outcome among children with visceral leishmaniasis.A cohort study in Belo Horizonte,Brazil,2010-2011[J].Mem Inst Oswaldo Cruz,2014,109(2):147-153.
[16]Agenor Araújo Lima Verde F,Araújo Lima Verde F,De Francesco Daher E,et al.Renal tubular dysfunction in human visceral leishmaniasis(Kala-azar)[J].Clin Nephrol,2009,71(5):492-500.
[17]Daher EF,Soares DS,Filho SL,et al.Hyponatremia and risk factors for death in human visceral leishmaniasis:new insights from a cross-sectional study in Brazil[J].BMC Infect Dis,2017,17(1):168.