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目的回顾性分析输入性疟疾并发肝功能损害的临床特点。方法收集2005年3月至2015年12月广州市第八人民医院收治的疟疾患者405例,其中并发肝功能损害的185例疟疾病患者资料进行分析。采用血涂片法确诊及做虫种鉴定。结果共纳入405例患者,无肝功能损害组220例,有肝功能损害组185例;患者以男性为主(占87.41%),平均年龄(36.52±10.27)岁。有肝功能损害组与无肝功能损害组比较,住院天数延长,肝肾功能及凝血功能较差,且并发症发生率高,并且有3例死亡病例。有肝功能损害组再分为普通疟疾患者155例,重症患者30例;临床表现以发热(97.30%),疲乏(63.24%),恶心(26.49%),呕吐(23.24%),黄疸(66.49%),贫血(69.19%)为主,实验室特征为转氨酶轻~中度升高,胆红素升高及低蛋白血症等;重症患者的疲乏、恶心、呕吐、黄疸、酱油样小便、瘀点瘀斑、球结膜水肿、肝脾肿大及胸腔积液等发生率明显高于普通型疟疾患者,ALT、总胆红素等值的升高明显高于普通疟疾,白蛋白下降程度明显大于普通疟疾。99.26%患者治愈出院。结论疟疾合并肝损害患者的消化道症状较轻,黄疸型肝炎较多,重症疟疾的肝损害发生率高,程度重。
Objective To retrospectively analyze the clinical features of imported malaria complicated with liver dysfunction. Methods A total of 405 cases of malaria patients were collected from the Eighth People’s Hospital of Guangzhou from March 2005 to December 2015. The data of 185 cases of malaria patients with liver dysfunction were analyzed. Blood smear diagnosis and identification of insect species. Results A total of 405 patients were enrolled. There were 220 patients without liver dysfunction and 185 patients with liver dysfunction. The patients were predominantly male (87.41%) and the mean age was (36.52 ± 10.27) years old. Compared with the group without liver dysfunction, the number of days of hospitalization was prolonged, the liver and renal function and coagulation function were poor, and the complication rate was high. There were 3 deaths. There were 155 cases of common malaria patients and 30 cases of severe cases. The clinical manifestations were fever (97.30%), fatigue (63.24%), nausea (26.49%), vomiting (23.24%), jaundice (66.49% ), And anemia (69.19%). The laboratory features mild to moderate aminotransferase, elevated bilirubin, hypoproteinemia, etc. Patients with severe symptoms of fatigue, nausea, vomiting, jaundice, soy sauce-like urine, The incidence of ecchymosis, conjunctival edema, hepatosplenomegaly and pleural effusion was significantly higher than that of ordinary malaria patients. ALT and total bilirubin were significantly higher than those of ordinary malaria. The decrease of albumin was significantly greater than that of malaria Common malaria. 99.26% of patients were cured and discharged. Conclusions Patients with malaria and liver damage have mild gastrointestinal symptoms, more jaundice hepatitis and severe liver damage with severe malaria.