西安市某医院2006—2021年输入性疟疾患者的流行病学及临床特征分析

目的 回顾性分析2006—2021年西安市某医院收治输入性疟疾患者的流行病学及临床特征。方法 详细采集2006年1月—2021年12月空军军医大学第二附属医院传染科收治的137例输入性疟疾患者的临床资料（从流行病学、临床分型、合并症、治疗及预后等方面分析其临床特征）。结果 纳入患者中有3例外籍人员,134例中国籍人员,患者发病前多有非洲或东南亚国家旅居史。恶性疟 111例（其中重型疟疾26例）、间日疟4例、卵型疟2例、三日疟2例、未分型18例。13例患者存在意识障碍（考虑脑型疟）,25例合并急性肾损伤,17例合并肺炎,4例因多脏器功能衰竭而死亡。65例（47.45%）患者病程中红细胞计数及血红蛋白低于正常下限,97例（70.80%）患者血小板低于正常下限,尿蛋白阳性者57例（41.61%）。71例（51.82%）患者使用抗疟药1 d后体温降至正常,35例（25.55%）患者2 d后体温降至正常,其余31例（22.63%）患者3~5 d后体温降至正常。126例患者治愈出院,复查血涂片疟原虫阴性;5例患者再燃;2例患者复发;4例患者死亡。患者平均住院时间8 d,平均住院费用9 261元,其中28例患者住院天数大于10 d,其住院治疗费用平均在2.04万元。结论 境外输入性疟疾仍是目前西安市定点医院收治的主要人群。掌握输入性疟疾的不同分型及重症疟疾发病特点,对指导临床医师早诊早治,提高救治水平具有重要意义。

Epidemiological and clinical characteristics of imported malaria in a hospital in Xi'an, 2006-2021

Objective To investigate the epidemiological and clinical characteristics of imported malaria in a hospital in Xi'an city from 2006 to 2021. Methods The clinical data of 137 imported malaria patients in Tangdu Hospital, Xi'an city, Shaanxi Province from Jan. 2006 to Dec. 2021 were collected to analyze the clinical characteristics, such as epidemiology, clinical classification, complications, treatment and prognosis. Results There were 3 foreign patients and 134 Chinese patients, most of them had traveled to Africa or Southeast Asian countries before onset. There were 111 cases of falciparum malaria (including 26 cases of severe malaria), 4 cases of vivax malaria, 2 cases of ovale malaria, 2 cases of malariae malaria and 18 cases of unclassified malaria. Thirteen cases with conscious disorder were cerebral malaria, 25 cases had acute renal impairment, 17 cases had complicated pneumonia, 4 cases were dead due to multiple organ failure. Sixty-five patients (47.45%) had lower RBC count and hemoglobin below the normal limit, 97 patients (70.80%) had lower PLT than the lower normal limit, and 57 patients (41.61%) had positive urine protein. The body temperature of 71 patients (51.82%) and 35 patients (25.55%) decreased to normal after 1 day and 2 days after antimalarial drugs therapy. The remaining 31 (22.63%) patients decreased to normal after 3-5 days of antimalarial treatment respectively. 126 patients were cured and discharged, and blood smear was negative for plasmodium. Five patients were suffered from recrudescence and two relapsed. The average hospitalization cost was 9 261 yuan for 8 days, 28 cases were hospitalized for more than 10 days, and the average hospitalization cost was 20 400 yuan. Conclusions Imported malaria is still the main population treated in hospitals in Xi'an. Mastering the clinical characteristics of different types of imported malaria, especially the severe malaria, is of great significance for guiding clinicians in early diagnosis and treatment of malaria.