内脏利什曼病死亡病例的临床分析

目的了解内脏利什曼病死亡病例的临床特点及实验室指标变化特征。方法分析北京友谊医院2013年1月—2018年6月4例内脏利什曼病死亡患者的临床资料,比较患者实验室指标的差异。结果 4例内脏利什曼病患者的病程3～12个月,患者均出现了多脏器的损伤,其中3例肝、脾大,2例出现中枢神经系统的损伤。4例患者利什曼原虫IgG抗体为阳性,骨髓涂片中均找到了利杜体。4例患者外周血常规的三系明显降低,清蛋白明显降低,球蛋白升高;4例患者的血清钠离子含量低于135 mmol/L。结论内脏利什曼病患者出现病程长,多脏器损伤,累及中枢神经系统,外周血常规三系显著降低,低蛋白血症,以及低钠血症均提示预后差,病死率高。

Clinical analysis on death cases of visceral leishmaniasis

Objective To understand the clinical characteristics and changes in laboratory indicators of patients died of visceral leishmaniasis (VL). Methods Clinical data of 4 patients died of VL in Beijing Friendship Hospital from January 2013 to June 2018 were analyzed, differences in laboratory indicators were compared. Results Disease course of 4 cases of VL ranged from 3 to 12 months, all patients had multiple organ damage, including 3 cases with hepatomegaly and splenomegaly, 2 cases with central nervous system damage. IgG antibodies of leishmania were positive in 4 patients, Leishman-Donovan body was found in bone marrow smears. Routine peripheral blood test results in 4 patients decreased significantly, albumin decreased significantly and globulin increased; level of serum sodium ion in 4 patients was lower than 135 mmol/L. Conclusion Long disease course, multiple organ damage, involvement of central nervous system, significant reducing in peripheral blood routine test results, hypoproteinemia, and hyponatremia in patients with VL all indicate poor prognosis and high mortality.