狂犬病早期临床表现与实验室诊断研究

目的对狂犬病的早期临床表现及实验室诊断进行分析,以提高临床早期诊断水平。方法对北京地坛医院2010年9月—2011年10月收治的经实验室检查确诊的9例狂犬病患者进行前瞻性研究,找出早期特异性表现,并对实验室特异性检测结果进行分析。结果所有患者在病程第1～2天均有低热、烦躁、完全失眠而不困倦等表现,这种状态可持续至病程的第3～4天。恐水、恐风、畏光等特征性症状多出现于病程的第3天及以后。所有患者外周血白细胞计数及中性粒细胞百分比明显升高,均值分别为(15.55±5.25)×109/L、(84.24±6.16)%。部分患者ALT、AST、BUN、CRE升高。所有患者CK明显升高,均值为(6931.9±1586.3)U/L。患者血液、脑脊液、唾液标本经反转录聚合酶链反应(reverse transcription-polymerase chain reaction,RT-PCR)检测,狂犬病病毒核酸为阳性者分别为2例(2/9)、2例(2/5)、4例(4/6)。8例(8/9)血液中的狂犬病病毒中和抗体滴度升高。结论低热、烦躁、完全失眠而不困倦等症状较恐水、恐风、畏光等出现更早,为狂犬病的早期特征。RT-PCR检测血液、脑脊液、唾液标本的狂犬病病毒核酸与快速免疫荧光灶抑制试验检测血清相结合,可作为狂犬病实验室诊断的有效方法。

Early clinical manifestations and laboratory diagnosis of rabies

Objective To analyze early clinical manifestations and laboratory detection of rabies so as to improve the early diagnosis of rabies.Methods A prospective study was conducted on 9 patients with rabies diagnosed by laboratory detection,who were admitted to Beijing Ditan Hospital from Sept.2010 to Oct.2011.The early clinical manifestations and specific laboratory detection results were analyzed.Results All the patients showed low-grade fever,dysphoria,and complete insomnia without drow-siness during the 1st and/or 2nd day of the disease course,which might continue until the 3rd and/or 4th day.Characteristic symptoms of rabies such as hydrophobia,anemophobia and photophobia did not appear until the 3rd day of the disease course.The leukocyte counts and the percentage of neutrophile granulocyte of peripheral blood increased obviously in all the patients,with the mean value of(15.55±5.25)×109 /L and(84.24±6.16)%,respectively.ALT,AST,BUN and CRE increased in some patients,and CK obviously increased in all the patients,with the mean value of(6 931.9±1 586.3) U/L.Two serum samples,2 cerebrospinal fluid(CSF) samples and 4 saliva samples were positive for rabies virus RNA by reverse transcription-polymerase chain reaction(RT-PCR).An increase in neutralizing antibody titers was found in 8 serum samples.Conclusions Low-grade fever,dysphoria and complete in-somnia without drowsiness appear earlier than hydrophobia,anemophobia and photophobia,and can be considered as early clinical features of rabies.Determination of rabies virus from serum,CSF and saliva samples by RT-PCR and of serum neutralizing antibodies to rabies virus by rapid fluorescent focus inhibition test can serve as efficient methods for laboratory diagnosis of rabies.