摘要目的 分析67例恙虫病患者的临床特点及免疫学特征.方法 回顾性分析2010年1月至2013年12月在南京医科大学第一附属医院住院治疗的67例恙虫病患者的流行病学资料、临床体征表现、实验室及影像学检查结果,治疗情况.结果 67例恙虫病患者发病以秋冬型为主,10、11月高发.临床体征:临床上以发热(100.0％,67/67)、焦痂或溃疡(91.0％,61/67)、斑丘疹(52.2％,35/67)及外周淋巴结肿大(46.3％,31/67)为主要表现.血液指标:①血常规检查:80.6％(54/67)的患者白细胞(WBC)数量正常[(4～10)×109/L]或低于正常值,其中62.7％(42/67)的患者淋巴细胞(Lym)百分比＞40％;34.3％ (23/67)的患者血小板(PLT)计数＜100×109/L,最低值为14×109/L.②外周血淋巴细胞亚群检查:共有17名患者进行此项检查.其中82.4％(14/17)的患者CD3+T细胞比例正常,82.4％(14/17)例CD4+T细胞比例降低,94.1％(16/17)的患者CD8+T细胞比例升高,88.2(15/17)的患者B淋巴细胞比例降低.③炎症指标检查:95.2％(59/62)的患者C反应蛋白(CRP)升高,93.8％(45/48)的患者铁蛋白升高,89.1％(49/55)的患者红细胞沉降率(ESR)加快.④肝功能检查:77.6％(52/67)的患者丙氨酸氨基转移酶(ALT)水平升高,80.6％(54/67)的患者天门冬氨酸氨基转移酶(AST)水平升高.⑤腺苷脱氨酶(ADA)检查:94.6％(35/37)的患者ADA升高.⑥抗核抗体(ANA)检查:31.0％(13/42)的患者ANA水平升高.⑦EB病毒检查:15.6％(7/45)的患者EB病毒DNA(+).77.6％(38/49)的患者胸部影像学异常.2例临床诊断为伴有结核菌感染,治疗以喹诺酮类或大环内酯类抗生素抗感染治疗为主,67例患者均痊愈.结论 67例患者秋冬型恙虫病临床表现典型,且存在免疫紊乱现象.

abstractsObjective To study the clinical and immunologic features of 67 cases of patients with scrub typhus.Methods Epidemiological data,clinical manifestations,laboratory and image examination results and treatment of 67 cases of patients with scrub typhus hospitalized from January 2010 to December 2013 at the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.Results Autumn-winter type scrub typhus was predominant in the 67 patents.The main clinical manifestations included hyperpyrexia (100％,67/ 67),eschar or ulcer (91.0％,61/67),rash (52.2％,35/67),lymphadenopathy (46.3％,31/67) and other non-specific symptoms.Laboratory test results:①80.6％ (54/67) of the patients had normal or decreased white blood cell count,62.7％ (42/67) of them with elevated lymphocytes (＞ 40％),thrombocytopenia was detected in 34.3％ (23/67) of the patients,the lowest platelets count was 14 × 109/L.②14 of 17 cases (82.4％) had normal percentage of CD3+ T lymphocytes,CD8+ T lymphocytes increased in 16 of 17 cases (94.1％),while the percentage of CD4+ T lymphocytes (14 of 17,82.4％) and B lymphocytes (15 of 17,88.2％) decreased in most of the patients.③C reactive protein (CRP),ferritin and erythrocyte sedimentation rate (ESR) were elevated in 95.2％ (59/62),93.8％ (45/48) and 89.1％ (49/55) of the patients,respectively.④Elevated alanine aminotransferase (77.6％,52/67) and aspartate aminotransferase (80.6％,54/67) were frequent findings.⑤94.6％ (35/37) of the patients had increased adenosine deaminase.⑥ Antinuclear antibody was positive in 31.0％ (13/42) patients.⑦Epstein-barr virus DNA was detected in 15.6％ (7/ 45) cases,77.6％ (38/49) was accompanied with chest radiographic abnormalities.Two cases had tuberculosis.All the patients recovered after therapy with doxycycline,levofloxacin or moxifloxacin.Conclusion Autumn-winter scrub typhus has typical clinical manifestations in the 67 patients,and it can cause patients' immune disorders.