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目的探讨输入性恶性疟的流行病学及临床特征。方法回顾性分析2008年1月—2013年6月诊治的28例患者的临床资料。结果 6例有缅甸、22例有非洲旅居史且无明显的流行季节特征;以中、高热为主且热型各异,16例有寒战、发热、出汗典型经过,其他为畏寒和寒战、肌肉酸痛、消化道症状;体征主要为贫血,皮肤和巩膜黄染,肝、脾肿大;实验室检查主要为血小板(PLT)减少和红细胞比容(Hct)降低,乳酸脱氢酶(LDH)、C-反应蛋白(CRP)、D-二聚体和降钙素原(PCT)升高;恶性疟组与健康对照组比较,白细胞、PLT、血红蛋白、Hct下降及LDH、CRP、D-二聚体、PCT升高和肝功能异常的差异有统计学意义;本组患者误诊率85.7%。结论输入性恶性疟无明显的流行季节特征,临床表现复杂易误诊,PLT减少、Hct降低、LDH、CRP、D-二聚体及PCT升高可能是早期诊断的重要线索。
Objective To investigate the epidemiology and clinical features of imported falciparum malaria. Methods The clinical data of 28 patients diagnosed and treated from January 2008 to June 2013 were retrospectively analyzed. Results There were 6 cases of Burma, 22 cases of African living history and no obvious epidemic season characteristics; mainly in the medium and high fever and the heat of different types, 16 cases of chills, fever, sweating typical after the other chills and chills , Muscle soreness, gastrointestinal symptoms; signs of anemia, skin and scleral yellow dye, liver, splenomegaly; laboratory tests mainly for the reduction of platelet (PLT) and hematocrit (Hct) decreased lactate dehydrogenase CRP, D-dimer and procalcitonin (PCT). The levels of leukocyte, PLT, hemoglobin, Hct and the levels of LDH, CRP and D- Dimer, PCT increased and abnormal liver function was statistically significant; misdiagnosis rate of 85.7% in this group of patients. Conclusions There is no obvious epidemic seasonal characteristics of imported P. falciparum. Complex clinical manifestations are easily misdiagnosed, PLT decreased, Hct decreased, LDH, CRP, D-dimer and PCT elevated may be important clues in early diagnosis.