Pertuiset E, Fen Chong M, Duval G, Génin R
Service de néphrologie hémodialyse, CHD Félix Guyon, Saint-Denis, la Réunion.
Rev Med Interne. 1988 Nov-Dec;9(5):487-93. doi: 10.1016/s0248-8663(88)80012-2.
Human leptospirosis of the classical and severe icterohemorrhagic type, usually due to the L. icterohaemorrhagiae serogroup, is frequent in La Réunion. In a retrospective study conducted between 1980 and 1984 in 249 adult patients, the mortality rate was 13 p. 100. Our data and those found in the literature indicate that the main cause of death is pneumopathy, followed by profuse haemorrhages, arrhythmias and cardiovascular collapse. Acute renal failure is common and often severe; it facilitates gastrointestinal bleeding and is of poor prognosis, particularly in patients with prolonged anuria, a possible cause of lethal hyperkalaemia. Other factors of unfavourable outcome have been demonstrated statistically; they include disturbances of consciousness, hypoprothrombinaemia, epigastric muscle rigidity, hyperleukocytosis, thrombocytopenia, high aspartate aminotransferase levels and chronic alcoholism. At the moment, pulmonary, cardiac and haemorrhagic complications concur with renal failure to darken the prognosis of these severe forms of leptospirosis.
在留尼汪岛，由黄疸出血群钩端螺旋体引起的典型重症黄疸出血型人钩端螺旋体病很常见。在1980年至1984年间对249例成年患者进行的一项回顾性研究中，死亡率为13%。我们的数据以及文献中的数据表明，主要死因是肺病，其次是大量出血、心律失常和心血管衰竭。急性肾衰竭很常见且往往很严重；它会促使胃肠道出血，预后不良，尤其是在无尿期延长的患者中，这可能是致命高钾血症的一个原因。其他不良预后因素已得到统计学证实；包括意识障碍、低凝血酶原血症、上腹部肌肉僵硬、白细胞增多、血小板减少、高天冬氨酸转氨酶水平和慢性酒精中毒。目前，肺部、心脏和出血性并发症与肾衰竭共同导致这些严重型钩端螺旋体病的预后恶化。
