Clinical observation of liver damages in epidemic hemorrhagic fever]

OBJECTIVE: To study the changes in liver function in patients with epidemic hemorrhagic fever (EHF). METHOD: A retrospective analysis of the laboratory tests of liver function in 103 patients with EHF and control subjects was carried out. RESULTS: The alanine aminotransferase (ALT), serum bilirubin (SB) and albumin levels in patients with severe and critical liver damages significantly differed from those in milder cases, and more sever liver damages were found in the death cases of EHF than in survived patients in terms of ALT and SB increment (P=0.000). The liver damage was related to the clinical type, age and the levels of blood platelet , albumin, lactic dehydrogenase and creatinine in EHF cases (P=0.000, 0.000, 0.030, 0.010, 0.000 and 0.013, respectively). CONCLUSIONS: Liver damage is common in patients with EHF and exacerbates with the severity of the disease. Monitoring of ALT, SB and albumin is helpful for evaluating the progression and prognosis of EHF.     

流行性出血热患者四种体液因子变化及其临床意义

目的：探讨流行性出血热患者血清肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡＴ－Ⅱ）、内源性类洋地黄物质（ＥＤＬＳ）和心房利钠因子（ＡＮＦ）变化及其临床意义。方法：６３例９７份标本及对照组２６例４种体液因子均采用放免法测定。结果：４种体液因子在ＥＨＦ各病期中与对照组相比均有升高，但以低血压休克期和少尿期升高最为显著，其中，ＡＮＦ少尿期高于低血压休克期。而ＥＤＬＳ则相反。相关分析显示ＰＲＡ、ＥＤＬＳ、ＡＮＦ和     

流行性出血热的调查报告

目的对兰州市首次发生的流行性出血热进行流行病学调查。方法对密切接触人群进行流行性出血热流行病学调查和抗体检测;对其居住周围进行鼠密度监测及流行性出血热抗原检测。结果人群出血热IgG阳性率2.5%,受检人员均为外省外地来兰人员;居住地鼠密度35.0%;鼠流行性出血热抗原检出率为10.9%。结论应加强城市环境卫生的管理,使灭鼠工作长期化制度化,消除传染病发生的潜在传染场所。     

出血热误诊为上呼吸道感染1例

1病例报告患者,男,22岁,因间歇性全身乏力、肌肉酸痛2 wk,发冷1 wk,发热4 d入院.曾在我院查WBC 4.5×109/L,N 0.60,L 0.4,体温波动在38～40℃.初步诊断"上呼吸道感染",用阿莫西林、VC银翘片、清热解毒冲剂等治疗无效.查体:T 38.9℃,BP面性12/8 kPa.全身皮肤无出血点,双眼球结膜轻度充血,咽部充血,软腭未见充血点,心肺腹部未见阳性体征.实验室检查:WBC 7.85 × 109/L,N 0.79,L 0.21,HGB 150g/L,PCL30×109/L,尿蛋白3.2g/L,流行性出血热抗体( ).诊断:流行性出血热.入院后立即按照流行性出血热的治疗原则给予抗病毒、抗渗出、抗出血治疗.具体包括卧床休息,给予高热量,多维生素,易消化饮食;维持水、电解质、酸碱及血浆渗透压平衡;给予大剂量(5 g)Vit.C和Vit.E.同时给予氢化可地松100 mg/d,稀释后缓慢静脉滴注.入院后3 d患者的尿量由450 mL/d增至750 mL/d,肌酐204.6μmol/L,BUN 13.3 mmol/L.5 d尿量增加至4000 mL/d.经综合治疗10 d,肌酐和BUN检查等正常,痊愈出院,随访1 mo未见异常.     

流行性出血热的各期护理

目的 探讨流行性出血热的各期的护理措施要点。方法 对52例流行性出血热各期护理措施的特点,进行总结,并认真做好住院及出院的指导。结果 对52例流行性出血热病人护理措施得当,效果良好。无1例发现严重并发症。结论 采取积极有效的护理措施是保证有效治疗的关键。     

流行性出血热急性肾功能衰竭的透析治疗

流行性出血热急性肾功能衰竭34例，其中21例血透，13例腹透。两组透析前少尿天数无显著差异（P＞0．05），BUN腹透组高（0．05＞P＞0．01），Scr血透组高（P＜0．01），出血倾向无显著差异。透析后，存活者少尿持续天数、住院天数以及两组出血倾向均无显著差异（P＞0．05），但腹透组感染率极高（P＜0．01），死亡率亦高（0．05＞P＞0．01）     

流行性出血热患者并发肝脏损害的临床观察

目的 探讨流行性出血热(EHF)病程中肝功能的变化及其临床意义.方法 对103例EHF患者的肝功能检测结果进行回顾性分析.结果 (1)重型及危重型患者肝脏的损害(ALT、SB及白蛋白)较轻型、中型患者有显著性差异;(2)死亡组肝脏的损害(ALT、SB)显著重于存活组(P值分别为0.000;0.000);(3)肝脏的损害(ALT)与患者的临床类型、年龄、血小板、白蛋白、乳酸脱氢酶及肌酐密切相关.结论 EHF患者并发肝脏损害较普遍,以轻、中度肝脏损害多见,而且与患者的临床类型、年龄、血小板、白蛋白、乳酸脱氢酶、肌酐及预后密切相关.病情愈重者,肝脏损害愈严重.因此在流行性出血热(EHF)病程中动态观察肝功能的变化,有助于判断病情和估计预后.     

Experimental studies on the transmission of hemorrhagic fever with renal syndrome virus by gamasidea mites and fleas]

Hemorrhagic fever with renal syndrome (HFRS) virus was isolated from 3 species of gamasidea mites (Haemolaelaps glasgowi, Laelaps jettmari, Eulaelaps shanghaiensis), and 2 species of fleas (Monopsyllus anisus, Leptopsylla segnis) collected from nests of HFRS virus-infected Apodemus agrarius, whereas HFRS virus was not recovered from Gamasidea mites and fleas collected from nests of uninfected Apodemus agrarius. It was thus confirmed that HFRS is a disease of animal origin with natural foci of infection. Experimental studies demonstrated that positive results of virus isolation were obtained from originally healthy population of Monopsylla anisus, Leptopsylla segnis and Haemolaelaps glasgowi 24-48 hours after they had sucked HFRS virus suspension, while positive results of virus isolation were still obtained from Haemolaelaps glasgowi but not from 2 species of fleas 7 days after they had sucked HFRS sirus suspension. It was confirmed that Monopsylla anisus and Leptopsylla segnis cannot propagate HFRS, and therefore their transmission would be mechanical. On the contrary, Haemolaelaps glasgowi might play the role of biological vector.     

流行性出血热并发呼吸衰竭持续血液透析滤过治疗

目的：探讨持续性静脉血液透析滤过在治疗流行性出血热并发急性呼吸衰竭中的临床价值。方法：对１０例流行性出血热并发急性呼吸衰竭患者行持续静－静脉血液透析滤过,每次持续１２ｈ,同时观察治疗前后血尿素氮、肌酐的变化及监测动脉血氧饱和度、氧合指数（ＰａＯ２／ＦｉＯ２）、呼吸频率、中心静脉压、平均动脉压,心率。结果：肌酐、尿素氮、中心静脉压下降（Ｐ〈０．００１）,氧饱和度、氧合指数有所改善（Ｐ〈０．００１）,     

流行性出血热肝脏损害研究进展

世界上人类病毒性出血热共有13种，根据该病肾脏有元损害，分为有肾损及无肾损二大类，在我国主要为肾综合征出血热（EHF,hemorrhagicfeverwithrenalsyndrome）。在病原体未解决前，在我国称流行性出血热（EHF，epidemichemorrhagicfever）；在朝鲜称朝鲜出血热（KHF,koreanhemorrhag—icfever）；在苏联称出血性肾病肾炎（HNN，hemorrhagicne—phrosonephritis）；由于特异性血清学诊断的确立及病原学的解决，1982年世界卫生组织统一定名为肾综合征出血热，但我国现仍沿用流行性出血热的病名。     

Interruption of early viremia in patients with epidemic hemorrhagic fever

Kinetic changes of viremia were observed in 287 patients with epidemic hemorrhagic fever (EHF) in whom ribavirin was administered with a double blind random controlled study by means of virus isolation, indirect immunofluorescence technique and ELISA. The positive rate of viremia was 79.7%, and the positive rate of EHF IgM was 85.0% before treatment. Viremia could be interrupted by ribavirin. In the ribavirin group, the positive rate of viremia decreased, duration of viremia was shortened, viral antigen products, viral titer and EHF IgG level were reduced as compared with the control group. These showed that viremia is very frequent in patients in the febrile phase, and ribavirin is an effective antiviral drug in treatment of EHF during the febrile phase. Dosage of the drug and the course of treatment are discussed.