Center for Stem Cell Research and Application, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China.
Int J Infect Dis. 2011 Dec;15(12):e859-66. doi: 10.1016/j.ijid.2011.09.008. Epub 2011 Oct 19.
The incidence of human granulocytic anaplasmosis (HGA), a tick-borne disease caused by the obligate intracellular bacterium Anaplasma phagocytophilum, has increased across the world. However, information on HGA is lacking in China. The purpose of this study was to investigate the clinical features and outcomes of HGA patients in China.
A total of 83 patients with HGA from the provinces of Hubei and Henan in China, who were admitted to Union Hospital between March 2009 and September 2010, were included in this study. We investigated the epidemiology, clinical features, laboratory markers, and therapeutic effects in these patients. We also analyzed life-threatening complications such as systemic inflammatory response syndrome (SIRS)/multiple organ dysfunction syndrome (MODS) following HGA and assessed the risk factors for a poor clinical outcome.
In our study, an HGA outbreak peak was observed for the months May to August. The highest age-specific incidence occurred among the group of patients aged 50-59 years. With regard to patient occupation and pathological origin, we found that 73 of the 83 patients with HGA had a peasant occupation. With respect to symptoms, 45 patients had no complications and 38 patients diagnosed with HGA met SIRS criteria, of whom 25 rapidly developed MODS. The mortality for the entire cohort was 26.5%. The factors predictive of patients developing MODS and an adverse outcome were advanced age, disturbance of consciousness, highly elevated lactate dehydrogenase, creatinine, and aspartate aminotransferase levels, and the presence of SIRS. Moreover, MODS was found to be an independent predictor of death.
In China, HGA patients had severe clinical symptoms and high rates of complications and mortality. These findings may provide useful information so that physicians will be on the alert for severe complications after a diagnosis of HGA; they will also be useful for optimizing supportive care for HGA-related critical illness. Prompt treatment and close monitoring of severe complications such as SIRS and MODS are of great importance in saving patient lives.
由专性细胞内细菌嗜吞噬细胞无形体引起的人粒细胞无形体病（HGA）是一种蜱传疾病，其发病率在全球范围内呈上升趋势。然而，中国对 HGA 的信息了解甚少。本研究旨在调查中国 HGA 患者的临床特征和结局。
本研究共纳入 2009 年 3 月至 2010 年 9 月期间在中国湖北省和河南省住院的 83 例 HGA 患者。我们调查了这些患者的流行病学、临床特征、实验室标志物和治疗效果。我们还分析了 HGA 后发生的威胁生命的并发症，如全身炎症反应综合征（SIRS）/多器官功能障碍综合征（MODS），并评估了不良临床结局的危险因素。
在本研究中，我们观察到 HGA 爆发高峰出现在 5 月至 8 月。年龄特异性发病率最高的是 50-59 岁年龄段的患者。就患者职业和病理来源而言，我们发现 83 例 HGA 患者中有 73 例为农民。就症状而言，45 例患者无并发症，38 例 HGA 患者符合 SIRS 标准，其中 25 例迅速发展为 MODS。整个队列的死亡率为 26.5%。预测患者发生 MODS 和不良结局的因素是年龄较大、意识障碍、乳酸脱氢酶、肌酐和天冬氨酸转氨酶水平显著升高，以及存在 SIRS。此外，MODS 是死亡的独立预测因素。
在中国，HGA 患者的临床症状严重，并发症和死亡率高。这些发现可为医生提供有用的信息，以便在诊断 HGA 后警惕严重并发症；对于优化与 HGA 相关的危重病支持性护理也具有重要意义。及时治疗和密切监测 SIRS 和 MODS 等严重并发症对于挽救患者生命至关重要。
