武汉市106例输入性恶性疟病例血液检验指标分析

目的 探讨输入性恶性疟血液临床检验指标特征,为诊断及预防重症提供科学依据。方法 收集2010—2017年武汉市输入性恶性疟确诊病例入院第1次的血常规和生化检验结果,将病例资料分为重症组和普通组,采用Wilcoxon秩和检验和t检验分析两组差异性。结果 共收集106份较完整的病例血液检测结果,其中重症组20例、普通组86例,血常规结果显示重症组红细胞（2.77±0.87）×10¹²/L、血红蛋白（84.52±25.57）g/L、红细胞压积（24.70±7.12）%,与普通组差异有统计学意义（P均<0.01）;同时重症组血小板均明显下降,差异有统计学意义（P<0.05）。生化结果显示重症组和普通组总胆红素（M=63.40,32.60）、直接胆红素（M=27.65,12.85）、间接胆红素（M=29.35,18.40）均明显上升,差异有统计学意义（P<0.05）;重症组天门冬氨酸氨基转移酶中位数82.00 U/L,与普通组差异有统计学意义（P<0.05）;重症组总蛋白（51.79±6.00） g/L、白蛋白（27.52±3.61） g/L,与普通组差异有统计学意义（P均<0.01）。重症组肾小球滤过率（56.06±42.05） mL/min、尿素（14.91±9.71） mmol/L、肌酐（161.93±36.21） μmol/L、胱抑素C 中位数2.22 mg/L,与普通组差异有统计学意义（P<0.01）。两组乳酸脱氢酶均明显上升,重症组（978.65±653.65）U/L,与普通组差异有统计学意义（P<0.01）;重症组钙下降,与普通组差异有统计学意义（P<0.01）。结论 恶性疟重症以严重贫血、低蛋白血症、严重肝肾功能损伤、乳酸脱氢酶升高及钙代谢紊乱为特征,对恶性疟重症诊断与预防具有一定的参考价值。

Analysis of the blood index in 106 imported falciparum malaria cases in Wuhan

Objective To investigate the characteristics of blood clinical indicators of imported falciparum malaria, and provide scientific basis for diagnosis and prevention of severe cases. Methods The first blood routine and biochemical test results of imported falciparum malaria cases in Wuhan from 2010 to 2017 were collected. The data were divided into severe group and normal group. The differences between the two groups were analyzed by Wilcoxon rank sum test and t test. Results A total of 106 complete clinical blood test results were collected, including 20 cases in the severe group and 86 cases in the general group. The results of routine blood test showed that RBC counts were (2.77±0.87)×10¹²/L, HGB (84.52±25.57) g/L and HCT (24.70±7.12)% in severe group, there were all significant differences between two groups (P<0.01). Then PLT decreased significantly in severe group , and significant difference with normal group (P<0.05). Biochemical results showed TBIL (M=63.40, 32.60), DBIL (M=27.65, 12.85) and IBIL(M=29.35, 18.40) increased significantly in both groups（P<0.05）. The median of AST was 82.00 U/L in severe group, and significant difference with normal group (P<0.05）. TP was (51.79±6.00) g/L and ALB was (27.52±3.61) g/L in severe group, and significant difference with normal group (P<0.01). Respectively, eGFR was (56.06±42.05) mL/min, UREA was (14.91±9.71) mmol/L, CREA was (161.93±36.21) μmol/L and CYSC was 2.22 mg/L, there were all significant differences between two groups (P<0.01). LDH increased significantly in both groups, that was (978.65±653.65) U/L in severe group, and significant difference with normal group (P<0.01). Then Ca decreased in severe group, and significant difference with normal group (P<0.01). Conclusion Severe cases of falciparum malaria were characterized by severe anemia, hypoproteinemia, severe liver and kidney dysfunction, elevated LDH and disturbance of Ca metabolism. The results had reference value for the diagnosis and prevention of severe falciparum malaria.