非洲输入性疟疾重症与非重症患者临床资料对照分析

目的 分析163例非洲输入性疟疾患者的临床资料,为尽早识别重症疟疾提供参考。方法 收集广州医科大学附属市八医院 2018年1月—2020年11月收治的163例非洲输入性疟疾患者临床资料,回顾性分析患者一般情况、临床症状、实验室检查、治疗及预后。结果 本研究共纳入163例患者,其中重症组37例,非重症组126例;平均年龄（37.90 ± 10.17）岁,男性患者147例（90.2%）,中国籍患者132例（81.0%）,既往有基础疾病患者15例（9.2%）;感染虫种以恶性疟原虫为主,144例（88.3%）。与非重症组相比,重症组患者的乳酸、降钙素原、白细胞计数、中性粒细胞计数、红细胞分布宽度变异系数、血小板平均体积、血小板分布宽度、凝血酶原时间、总胆红素、丙氨酸氨基转氨酶、天门冬氨酸氨基转氨酶、碱性磷酸酶、乳酸脱氢酶、三酰甘油、尿素、肌酐和胱抑素C均升高（P<0.05）,红细胞计数、血红蛋白、红细胞压积、血小板、白蛋白、总胆固醇、高密度脂蛋白、低密度脂蛋白和载脂蛋白AI均降低（P<0.05）。经积极治疗,重症组患者死亡1例,其余均治愈出院。结论 非洲输入性疟疾患者以恶性疟原虫感染为主。恶性疟疾发展成重症比例高,死亡率高。疟疾患者的血常规、乳酸、降钙素原、血脂、凝血功能以及肝肾功能的变化对重症疟疾有很好的预警作用,有助于尽早识别重症疟疾,提高治愈率,降低死亡风险。

Comparative analysis of clinical data of severe and non-severe imported malaria patients from Africa

Objective To provide references for the early identification of severe malaria, by analyzing the clinical data of 163 imported malaria patients from Africa. Methods The clinical data of 163 cases of imported malaria patients from Africa were collected in the Guangzhou Eighth People's Hospital, Guangzhou Medical University from January 2018 to November 2020. The general condition, clinical symptoms, laboratory tests, treatment and prognosis of the patients were analyzed retrospectively. Results A total of 163 patients were divided into 37 severe cases and 126 non-severe cases in this study, of which the average age was (37.90 ± 10.17) years , 147 (90.2%) cases were male, 132 (81.0%) cases were Chinese, and 15 (9.2%) cases with previous underlying disease. The main infection species was Plasmodium falciparum, 144 cases（88.3%）. Compared with the non-severe group, the lactate, procalcitonin, white blood cell count, neutrophil count, red blood cell distribution width-correlation variance, mean platelet volume, platelet distribution width, prothrombin time, total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase, triglycerides, urea, creatinine and cystatin C were significantly increased (P<0.05), and the red blood cell count, hemoglobin, red blood cell specific volume, platelet count, albumin, total cholesterol, high-density lipoprotein, low-density lipoprotein and apolipoprotein AI were significantly reduced (P<0.05) in the severe group. With the active treatment, one patient was died in the severe group, the rest of the patients were cured and discharged. Conclusion The imported malaria patients from Africa were mainly infected with Plasmodium falciparum. The proportion of developing severe cases and the resulting mortality rate were both higher due to falciparum malaria. The changes of blood routine, lactate, procalcitonin, blood lipids, coagulation function and liver and kidney function of malaria patients have a good early warning effect on severe malaria. These indicators will help identify severe malaria early, improve the cure rates, and reduce the risk of death.