探索建立临床表现联合实验室检测诊断恙虫病的积分体系。

分析2015年临床确诊的16例恙虫病患者临床表现和血常规、降钙素原、肝功能、肾功能、心肌酶谱和凝血功能检验结果。设立恙虫病临床表现联合实验室检查的积分系统，将临床表现分为1类临床表现（发热、焦痂，每项积2分）、2类临床表现（皮疹、野外生活史，每项积1分），3类临床表现（呼吸系统如咳嗽、咯痰等；消化系统便血、腹胀、恶心等；心血管系统如心悸、胸闷等；神经系统如嗜睡、谵妄等，积0.5分）；将白细胞总数、嗜酸性粒细胞计数、降钙素原定位1类实验室证据（每项积1分），将肝功能、肾功能、心肌酶谱、凝血功能异常定为2类实验室证据（每项积0.5分），汇总患者临床表现和实验室检查的积分。对比分析抗-恙虫病东方体检测和巢式PCR检测恙虫病东方体结果与积分系统的相关性。探索根据临床表现联合实验室检查临床诊断恙虫病的可能性。

抗-恙虫病东方体阳性率为93.75%（15/16），焦痂巢式PCR检测恙虫病东方体检测阳性率为100%（4/4）。全部恙虫病患者临床表现联合实验室检查积分系统≥ 8.5分者，其抗-恙虫病东方体阳性和（或）焦痂巢式PCR检测恙虫病东方体的阳性。

通过建立恙虫病临床表现联合实验室检查积分体系，有利于在无抗-恙虫病东方体检测或PCR检测恙虫病东方体条件下临床诊断恙虫病。

To explore and establish a new integral system of diagnosis of Scrub typhus by clinical manifestation combined with laboratory detection.

Total of 16 clinical cases with scrub typhus infection were collected from January to October in 2015. The epidemiological history of outdoor life, the clinical manifestations including fever, eschar, rash, clinical manifestations of the clinical signs and symptoms and the clinical examinations including blood test, procalcitonin, hepatic function, kidney function, cardiac creatase and blood coagulation function were analyzed, respectively. The integral system including clinical manifestation and laboratory tests were established, respectively. The clinical manifestation were divided into three classes. The first class including fever and eschar, each index was two scores; the second class including rash and history of outdoor life, each index was one score; the third class including respiratory symptom such as cough, expectoration, gastrointestinal symptom such as hematochezia, abdominal distension and nausea; cardiovascular symptom such as palpitation, chest congestion; neurological syndrome such as sleepiness, delirium, each index was one half score. The lab test was divided into two classes. The total counts of white blood cells (WBC), eosinophil count and procalcitonin were defined as laboratory evidence one, each index was one score; the testing index of hepatic function, kidney function, cardiac creatase and blood coagulation function were defined as laboratory evidence two, each index was one-half score. The integral from the clinical manifestation and laboratory diagnosis was calculated and its correlation between the result from immunology test of scrub typhus and integral system was analyzed. The scrub typhus was diagnosed by integral system combined clinical manifestation with laboratory detection instead of immunology test.

The antibody positive rate of Orientia tsutsugamushi was 93.75% (15/16). The antibody positive rate of Orientia tsutsugamushi tested by nest-PCR was 100% (4/4). The patients whose scores from new integral system was ≥ 8.5 scores, while the antibody of Orientia tsutsugamushi was positive.

The scores system combined with clinical manifestation and laboratory diagnosis is established, which would help to detect scrub typhus in clinical trials without antibody of Orientia tsutsugamushi or nest-PCR method.