以发热和肺部多发病灶为特征的非典型麻疹综合征51例临床分析

目的 探讨非典型麻疹综合征(AMS)的临床及肺部影像学特征,提高对该病的认识和诊断水平.方法 回顾性分析2007年5月21日山西省某中学暴发的51例AMS患者的临床表现、实验窜检查和胸部影像学表现,并结合文献进行复习.结果 51例中男31例,女20例,年龄18～33岁,平均20岁.临床表现为发热50例,头痛、头晕44例,乏力31例,流涕1例,咽痛10例,咽充血9例,咳嗽5例,咳痰3例,胸闷、胸痛8例,呼吸困难3例,眼部不适及流泪13例,麻疹黏膜斑(Koplik 斑)1例,皮疹18例(大部分为充血性斑丘疹,最先起始于手足或胸背部).实验室检查:51例中入院时白细胞总数低于4×109/L者7例,(4～10)×109/L者39例,高于10×109/L者5例.淋巴细胞低于0.20者29例,0.20～0.40者20例,高于0.40者2例;中件粒细胞高于0.70者33例.尿常规检查13例尿蛋白和(或)尿潜血阳性;36例血C反应蛋白增高,肝功能异常2例,肾功能异常1例.48例胸部CT可见双肺单发或多发、大小不等、密度较低的结节病灶或小斑片状阴影,边界清楚,分布范围从肺尖到肺底、肺中带到胸膜下.结论 AMS临床表现不典型,上呼吸道卡他症状少见,出疹患者少,出疹顺序不典型;肺部受累者多,胸部影像学表现呈多样性;麻疹抗体的检测对减少AMS的误诊和漏诊有重要意义.

Clinical analysis of 51 cases of atypical measles syndrome characterized by fever and multiple lung lesions

Objective To investigate the clinical and chest radiological features of atypical measles syndrome(AMS),and therefore to improve the recognition and diagnosis of the disease.Methods The clinical features,laboratory tests and chest radiological manifestations of 51 cases of outbreak AMS in one hish school of Shanxi province were retrospectively analyzed.Results There were 31 males and 20 females,aging 18-33 years old.The main clinical presentations included fever(50/51),headache and dizziness (44/51),fatigue(31/51),nasal discharge(1/51),sore throat(10/51),cough(5/51),dyspnea(3/51),dacryorrhea(13/51),Koplik's spots(1/51),and skin rash(18/51)which were mostly congested maculopapules and firstly appeared on the hands,the feet and the back.Laboratory tests showed that the peripheral WBC count was in the normal range in most of the patients(n=39),and lower than normal in 7cases.The percentage of lymphocytes was less than 20% in 29,20%-40% in 20,and higher than 40% in 2 cases.The percentage of neutrophils was higher than 70% in 33 cases.Abnormal urianalysis(13/51)included positive urine protein and OB.High CRP(36/51),abnormal liver function(2/51),and abnormal renal function(1/51)were also observed.Forty-eight cases showed abnormal chest CT.manifested mostly as bilateral multiple lesions of different sizes and low density nodules and patchy areas,distributed randomly from apex to base,and from the middle zone to the pleura.Conclusions The clinical manifestation of AMS is atypical,characterized by the lower incidence of catarrh symptom and skin rashes with atypical appearance,but higher incidence of lung lesions.Familiarity with the atypical clinical manifestations and radiological features of AMS,epidemiological study and measles antibody detection are important for rapid and accurate diagnosis of the disease.