杭州市西溪医院66例输入性疟疾患者临床特征

目的 分析杭州市西溪医院2014年2月—2019年12月收治的疟疾患者临床资料及药物治疗情况,为临床早期诊断、评估轻重以及治疗提供参考数据,促进临床合理用药。方法 收集2014年2月—2019年12月收治入院的66例疟疾患者资料,分为轻症组和重症组,对两组患者的实验室检测指标结果、药物使用情况进行比较,并采用多因素二元Logistic 对两组患者的指标作逐步回归分析。结果 17例重症恶性疟患者治疗中,10例患者尽早、足量、足疗程使用青蒿琥酯针及后续双氢青蒿素哌喹片巩固治疗,效果良好。34例轻症恶性疟疾患者,28例单独使用双氢青蒿素哌喹片,效果敏感,治愈率高。8例间日疟和4例卵形疟,6例患者使用磷酸氯喹加磷酸伯氨喹八日方案,6例患者选用青蒿素类药物,效果均良好。经Pearson单因素分析,轻症组与重症组在年龄、治愈时间、白细胞、红细胞、血红蛋白、血小板、谷草转氨酶、总胆红素、C-反应蛋白及降钙素原间差异具有统计学意义（P<0.05）;经多元Logistic回归分析,影响疟疾轻重症分型的相关因素包括：年龄、白细胞计数、降钙素原。结论 青蒿素类注射液治疗后联用青蒿素类复方（ACTs）能更有效治疗重症恶性疟疾。在缺乏首选药物的情况下单用青蒿素类药物治疗间日疟、卵形疟效果良好。影响疟疾发病后重症化的因素有年龄、治愈时间、白细胞、红细胞、血红蛋白、血小板、谷草转氨酶、总胆红素、C-反应蛋白及降钙素原,其中年龄、白细胞及降钙素原对疟疾严重程度的预测评估意义重大。

Clinical characteristics of 66 imported malaria cases in Xixi Hospital of Hangzhou

Objective To analyze the clinical data and drug treatment of malaria patients Xixi Hospital of Hangzhou,February 2014- December 2019, and we provide reference data for early clinical diagnosis, assessment of severity and treatment, and promote rational clinical medication. Methods A total of 66 malaria patients admitted to hospital from February 2014 to December 2019 were collected to distinguish mild and severe cases. The laboratory test results and drug use of the two groups were compared, and the indicators of the two groups were analyzed by multi-factor binary Logistic Stepwise regression analysis. Results In the treatment of 17 patients with severe falciparum malaria,10 patients artesunate injection and subsequent dihydroartemisinin-piperaquine tablets were used to consolidate the treatment, and the treatment effect was good. Among 34 patients with mild falciparum malaria, 28 patients were treated with dihydroartemisinin-piperaquine tablets alone, with sensitive effect and high cure rate. For 8 cases of vivax malaria and 4 cases of ovale malaria, 6 patients were treated with chloroquine phosphate plus primaquine phosphate 8-day regimen, and 6 patients were treated with artemisinin-based drugs, and the treatment effect was good. There was statistically significant difference in age, cure time, white blood cells(WBC), red blood cells, hemoglobin, platelets, aspartate transaminase, total bilirubin, C-reactive protein and procalcitonin(PCT) between mild group and severe group (P<0.05). Multi-factor binary Logistic Stepwise regression analysis showed that the related factors influencing the severity of malaria included age, WBC and PCT. Conclusion Artemisinin-based injections combined with ACTs (Combinatorial therapy) are more effective in treating severe and malignant diseases. Artemisinin alone is effective in the treatment of vivax malaria and ovale malaria in the absence of preferred drugs. There are many factors, such as age, cure time, white blood cells, red blood cells, hemoglobin, platelets, aspartate transaminase, total bilirubin, C-reactive protein and procalcitonin, influencing the severity of malaria, among which age, leukocyte and procalcitonin are of great significance for the prediction and evaluation of malaria severity.