Gao Qin, Liu Yan-Bin, Zhong Ce-Jun, Lv Xiao-Ju
Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2013 Apr;31(2):135-7.
To analyze the clinical and epidemiological characteristics of visceral leishmaniasis cases in Sichuan.
The medical records of 137 patients with visceral leishmaniasis were reviewed between January 2000 and April 2012 in West China Hospital. The epidemiological data, clinical manifestations, laboratory features, diagnosis, therapeutic procedures and outcome of the patients were retrospectively analyzed.
Eighty-eight (64.2%) out of 137 cases were the residents in the endemic area of Sichuan Province and adjacent areas, and 49 (35.8%) were non-endemic area residents with a history of visiting endemic area. Patients living in rural areas accounted for 84.7% (116/137), in town for 15.3% (21/137). Visceral leishmaniasis should be strongly suspected in a patient with prolonged fever, marked hepatosplenomegaly, lymphadenectasis, cytopenia and hypergammaglobulinemia. All patients showed positive in rk39 dipstick test, and were treated with antimony sodium gluconate. Among these patients, 86.1% (118/137) were cured by drug, 2.9% (4/137) received splenectomy, and 6.6% (9/137) relapsed. The misdiagnosis rate was 23.4% (32/137).
Bone marrow smear staining and biopsy, combined with rk39 antibody detection and epidemiological history are crucial for early diagnosis and treatment of visceral leishmaniasis. Antimonials is still an effective therapeutic choice.
分析四川省内脏利什曼病病例的临床及流行病学特征。
回顾性分析2000年1月至2012年4月在华西医院就诊的137例内脏利什曼病患者的病历。对患者的流行病学资料、临床表现、实验室检查特征、诊断、治疗过程及转归进行回顾性分析。
137例患者中，88例（64.2%）为四川省及毗邻地区疫区居民，49例（35.8%）为有疫区旅居史的非疫区居民。居住在农村地区的患者占84.7%（116/137），城镇患者占15.3%（21/137）。对于长期发热、明显肝脾肿大、淋巴结肿大、血细胞减少及高球蛋白血症的患者，应高度怀疑内脏利什曼病。所有患者rk39试纸条检测均为阳性，均采用葡萄糖酸锑钠治疗。其中，86.1%（118/137）的患者药物治愈，2.9%（4/137）的患者接受了脾切除术，6.6%（9/137）的患者复发。误诊率为23.4%（32/137）。
骨髓涂片染色及活检，联合rk39抗体检测及流行病学史，对内脏利什曼病的早期诊断及治疗至关重要。锑剂仍然是有效的治疗选择。
