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目的通过对黑热病病例的分析,探讨黑热病的流行病学与临床特点,为临床减少误诊提供依据。方法对就诊患者采用rk39试纸条检测,阳性者收集流行病学、发病情况、临床表现以及其在医院的病原学、辅助检查和病历记录等资料,免费给予锑剂药物治疗;对资料进行整理、统计和回顾性分析。结果病例均有传播季节在流行区居住史;全年各月均有发病,非流行区病例以到九寨沟县、黑水县和甘肃、新疆流行区感染后发病的居多。发病男性高于女性。流行区16岁以下发病较多,占35.09%;非流行区以16岁及以上发病居多,占97.85%。病程最短者为7d,最长者达2年;主要临床表现为长期不规则发热占100.00%,进行性肝脾肿大占98.00%;以白细胞为主的全血细胞减少及血浆球蛋白增高分别占83.33%和93.18%。rk39试纸条检查与骨髓穿刺的阳性符合率为100.00%,rk39试纸条的检出率明显高于骨髓穿刺(P<0.01)。结论加强流行区居民和流动人口防病宣传,从流行病学入手控制黑热病;黑热病的早期诊断关键是了解流行病学资料,认识该病的临床特点,掌握骨髓或rk39试纸条检查方法,防止漏诊误诊。
Objective To analyze the epidemic and clinical characteristics of kala-azar by analyzing the cases of kala-azar and provide the basis for clinical misdiagnosis. Methods The patients were tested by rk39 test strips, and the positive persons were collected epidemiology, incidence, clinical manifestations and their etiology in the hospital, laboratory examinations and medical records and other data, free antimony agent drug treatment; , Statistical and retrospective analysis. Results The cases were all spread in the epidemic area during the seasons of the epidemic. The incidence was in all months of the year. The incidence of non-endemic areas was highest in the epidemic areas of Jiuzhaigou, Heishui, Gansu and Xinjiang. Incidence of men than women. Prevalence of endemic areas under the age of 16 more, accounting for 35.09%; non-endemic areas of 16 years of age and above the majority, accounting for 97.85%. The shortest duration of 7d, the longest 2 years; the main clinical manifestations of long-term irregular fever accounted for 100.00%, progressive hepatosplenomegaly accounted for 98.00%; leukocyte-based pancytopenia and plasma globulin were accounted for 83.33% and 93.18% respectively. The coincidence rate of rk39 test strip and bone marrow puncture was 100.00%. The detection rate of rk39 test strip was significantly higher than that of bone marrow puncture (P <0.01). Conclusion The prevention and control of residents and floating population in endemic areas should be strengthened so as to control kala-azar from epidemiology. The key to early diagnosis of kala-azar is to know the epidemiological data, understand the clinical features of the disease, master bone marrow or rk39 test strips, Miss misdiagnosis.