新型冠状病毒肺炎合并恶性疟3例的常规实验室指标分析

目的 对不明原因发热，尤其是新型冠状病毒感染并疟疾流行病史患者,分析新型冠状病毒合并疟原虫感染患者实验室指标，为两者的混合感染诊断提供实验室依据。方法 对广州医科大学附属市八医院2020年7—12月3例新型冠状病毒感染合并恶性疟患者的血常规、生化、淋巴细胞亚群等实验室项目进行检测，并结合病程变化进行阶段性分析。结果 3例新冠感染患者均有疟疾感染史，入院后第4～11天出现发热、头痛等症状，疟原虫抗原检测和血涂片检测均发现疟原虫，3例患者在确诊新冠感染后均出现疟疾复燃。新型冠状病毒肺炎合并恶性疟复燃患者初期淋巴细胞减少，CRP、SAA均升高，经抗疟治疗后逐渐恢复至正常水平；其余血常规结果（WBC、ESO）和肝功能结果（ALT、AST、GGT、TBIL、DBIL、CG）中仅1例患者疟原虫检出初期PLT降低，其他则在病程始末均未见异常。结论 新冠感染有可能促进疟疾复燃，所以对有疟疾感染史的新冠感染者应同时监测疟疾发病或复发情况，尤其是对新冠无症状感染者确诊后数天开始出现发热等症状患者，炎症指标可作为二者合并感染治疗有效的辅助判断依据。

Analysis laboratory results of three cases of COVID-19 complicated with falciparum malaria

Objective To analyze the laboratory indexes of patients infected with malaria patients and COVID-19, so as to provide reliable evidence for the diagnosis of mixed infection of both. Methods The routine clinical laboratory items such as routine blood, biochemistry and lymphocyte subsets were tested in three cases of COVID-19 complicated with falciparum malaria who admitted to Guangzhou Eighth People's Hospital Affiliated to Guangzhou Medical University from July to December 2020 were tested. Laboratory data were stage-wise analyzed in conjunction with changes in the course of disease. Results Three patients confirmed COVID-19 infection recruited all had malaria infection history. Fever, headache, and other symptoms emerged on the 4rd to 11th day after admission. Malaria parasite was detected by malaria parasite antigen testing and blood smear testing, and all three patients had re-ignition of malaria after being confirmed COVID-19 infection. In the early stage of malaria relapse, lymphocytes decreased, CRP and SAA increased, and gradually returned to normal level after antimalarial treatment. Interestingly, we only found one patient at the initial stage of malaria detection showed PLT decreased, no other unnormal changes in other routine blood results (WBC, ESO) and liver function results (ALT, AST, GGT, TBIL, DBIL, CG) were found from the beginning to end course of the disease. Conclusion COVID-19 infection may promote the resurgence of malaria, so the relapse of malaria should be monitored especially for the patient with malaria infection history who begin to develop fever and other symptoms a few days after the diagnosis of COVID-19. The inflammatory indicators would be worth able as an auxiliary judgment basis for the effective treatment of the two combined infection.