中国首例输入性裂谷热危重症病例的救治及随访

doi:10.3877/cma.j.issn.1674-1358.2018.01.020

中华实验和临床感染病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 98 -101. doi: 10.3877/cma.j.issn.1674-1358.2018.01.020

所属专题：经典病例；经典病例；文献；

病例报告

中国首例输入性裂谷热危重症病例的救治及随访

熊号峰¹, 李传胜¹, 谭建波¹, 刘玉凤¹, 孙瑶¹, 蒲琳¹, 向攀¹, 张铭¹, 刘景院¹^,^†(

)

^1. 100015　北京，首都医科大学附属北京地坛医院重症医学科

收稿日期:2017-02-27 出版日期:2018-02-15
通信作者: 刘景院
基金资助:
新发突发传染病研究北京市重点实验室资助课题(No. D09050703560908；DTKF-2016-04); 北京市医院管理局重点医学专业发展计划-新发突发传染病(No. ZYLX201602); 感染性疾病重症医学(No. ZYLX201827)

Clinical treatment and follow-up of the first critical cases of critical rift valley fever in China

Haofeng Xiong¹, Chuansheng Li¹, Jianbo Tan¹, Yufeng Liu¹, Yao Sun¹, Lin Pu¹, Pan Xiang¹, Min Zhang¹, Jingyuan Liu¹^,^†()

^1. Intensive Care Unit, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

Received:2017-02-27 Published:2018-02-15
Corresponding author: Jingyuan Liu
About author:
Corresponding author: Liu Jingyuan, Email: dtyyicu@ccmu.edu.cn

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引用本文：

熊号峰, 李传胜, 谭建波, 刘玉凤, 孙瑶, 蒲琳, 向攀, 张铭, 刘景院. 中国首例输入性裂谷热危重症病例的救治及随访[J]. 中华实验和临床感染病杂志(电子版), 2018, 12(01): 98-101.

Haofeng Xiong, Chuansheng Li, Jianbo Tan, Yufeng Liu, Yao Sun, Lin Pu, Pan Xiang, Min Zhang, Jingyuan Liu. Clinical treatment and follow-up of the first critical cases of critical rift valley fever in China[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(01): 98-101.

目的

探讨我国首例输入性裂谷热危重症病例的救治。

方法

对本院收治的我国首例输入性裂谷热危重症病例的临床资料、诊疗经过及预后进行回顾性分析。

结果

本例裂谷热危重症患者为45岁男性，在非洲务工两年回国，当地无裂谷热疾病流行。主要临床表现为发热、头痛、周身肌肉酸痛，进行性尿量减少。实验室检查提示肝、肾功能重度损伤。入院第3天，经中国疾病预防控制中心报裂谷热病毒核酸阳性，其他病原核酸均为阴性，确诊为裂谷热。经持续血液净化、保肝、稳定细胞膜以及对症支持治疗后，患者尿量逐渐增加，肝肾功能逐渐恢复正常，痊愈出院。门诊随访半年，肝肾功能均正常，视力无异常。

结论

裂谷热作为一种人畜共患病，传入我国的风险逐渐增加。急性肾功能衰竭、急性肝功能损伤是危重症裂谷热的主要表现，经过积极治疗，病情可有效控制。

关键词: 输入性传染病, 裂谷热, 危重症, 肾功能衰竭、急性, 肝功能损伤、急性

Objective

To investigate the treatment of the first case of rift valley fever in China.

Methods

The clinical data, treatments, prognosis and follow up data of the first case of rift valley fever in China were analyzed, retrospectively.

Results

This case of rift valley fever critically ill patient was male, 45 years old, living in Angela for 2 years, there were no rift valley fever epidemic. The main clinical manifestations were fever, headache, abdominal muscle pain, progressive reduction in urine output. Laboratory tests suggested severe liver and kidney function damage. On the third day of admission, the rift valley fever virus was reported positive by the Chinese CDC, and other pathogens were negative and rift valley fever was confirmed. After continuous blood purification, liver protection, stable cell membrane and symptomatic support treatment, the urine output was gradually increased, liver and kidney function gradually recovered. Outpatient follow-up for six months, liver and kidney function of the case were normal, and the patient was discharged.

Conclusions

As a zoonotic disease, the risk of rift valley fever incoming to China is gradually increased. Acute renal failure and acute liver injury are the main manifestations of critical rift valley fever, it could be effectively controlled after treatment.

Key words: Imported transmitted diseases, Rift valley fever, Critically ill, Acute renal failure, Acute liver injury

表1 患者住院期间实验室检查结果

指标	7月21日	7月22日	7月23日	7月26日	8月19日	8月29日
WBC （× 10⁹/L）	6.77	5.91	2.47	9.09	8.52	7.81
NE（%）	71.50	66.00	80.00	68.00	61.8	57.60
血色素（g/L）	155.40	137.00	143.00	129.00	94.00	89.00
血小板（× 10⁹/L）	99.00	104.00	81.00	85.00	335.00	261.00
ALT （U/L）	5 910.00	5 360.00	1 968.00	857.00	194.00	42.00
AST（U/L）	7 570.00	686.00	612.00	124.00	90.00	29.60
TBil（μmol/L）	83.80	96.00	59.00	46.00	16.00	10.00
DBil（μmol/L）	71.80	85.00	52.00	37.00	11.00	5.00
白蛋白（g/L）	36.80	31.60	30.90	28.90	49.00	43.00
尿素氮（mmol/L）	35.19	37.00	19.00	18.00	8.00	5.03
肌酐（μmol/L）	1 005.70	097.00	540.00	397.00	139.00	86.00
肌酸激酶同工酶（ng/ml）	86.00	70.00	26.00	25.00	20.00	15.00
C-反应蛋白（mg/L）	18.50	16.30	7.20	8.20	5.00	0.50
降钙素原（ng/ml）	71.78	50.50	34.00	1.00	0.22	< 0.05
血脂肪酶（U/L）	58.10	122.00	468.00	192.00	30.00	20.00
血淀粉酶（U/L）	132.00	65.90	284.00	67.00	50.00	45.00

表1 患者住院期间实验室检查结果

指标	7月21日	7月22日	7月23日	7月26日	8月19日	8月29日
WBC （× 10⁹/L）	6.77	5.91	2.47	9.09	8.52	7.81
NE（%）	71.50	66.00	80.00	68.00	61.8	57.60
血色素（g/L）	155.40	137.00	143.00	129.00	94.00	89.00
血小板（× 10⁹/L）	99.00	104.00	81.00	85.00	335.00	261.00
ALT （U/L）	5 910.00	5 360.00	1 968.00	857.00	194.00	42.00
AST（U/L）	7 570.00	686.00	612.00	124.00	90.00	29.60
TBil（μmol/L）	83.80	96.00	59.00	46.00	16.00	10.00
DBil（μmol/L）	71.80	85.00	52.00	37.00	11.00	5.00
白蛋白（g/L）	36.80	31.60	30.90	28.90	49.00	43.00
尿素氮（mmol/L）	35.19	37.00	19.00	18.00	8.00	5.03
肌酐（μmol/L）	1 005.70	097.00	540.00	397.00	139.00	86.00
肌酸激酶同工酶（ng/ml）	86.00	70.00	26.00	25.00	20.00	15.00
C-反应蛋白（mg/L）	18.50	16.30	7.20	8.20	5.00	0.50
降钙素原（ng/ml）	71.78	50.50	34.00	1.00	0.22	< 0.05
血脂肪酶（U/L）	58.10	122.00	468.00	192.00	30.00	20.00
血淀粉酶（U/L）	132.00	65.90	284.00	67.00	50.00	45.00

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