摘要
目的报告1例流行性出血热(EHF)合并2型糖尿病患者的诊治过程,为临床提供指导。方法2020年9月10日广州医科大学附属中医医院收治1例EHF患者,该患者入院后检测血常规,并进行肝、肾、心功能检查与电解质、血糖、外周血疟原虫和登革病毒抗体等各项检测以及影像学检查,根据结果综合分析。结果患者为40岁男性,入院3 d前无明显诱因出现腹泻、呕吐并进行性加重,1 d前出现气促症状,于2020年9月10日入院。结果显示,血小板计数(PLT)显著降低,肝肾功能异常,心肌酶指标异常增高,空腹血糖(FBG)与随机血糖水平均明显升高,EHF抗体免疫球蛋白M(IgM)检测阳性。西医诊断为EHF合并2型糖尿病,给予护胃、抗感染、调节肠道菌群、营养支持、纠正电解质紊乱等治疗,中医治疗以运脾祛湿为原则,处方以清肠利湿为法联合治疗,给予定向透药治疗以通经活络、行气止痛。经治疗患者症状明显改善,PLT恢复至正常范围,其余指标亦明显改善,患者于9月17日出院。结论EHF的表现形式多样,患者常因不典型症状就诊,当患者有发热史和PLT明显减少时要注意发生EHF的可能性,可以通过实验室检测血清特异性EHF抗体IgM,结合病史和患者临床表现得出诊断。尤其本例患者合并2型糖尿病,应引起警惕。
Objective To report the diagnosis and treatment of a patient with epidemic hemorrhagic fever(EHF)complicated with type 2 diabetes mellitus,and provide guidance for the clinic.Methods A patient with EHF was admitted to the Affiliated Traditional Chinese Medicine(TCM)Hospital of Guangzhou Medical University on September 10,2020.The clinical data of the patient were analyzed.After admission,the patient underwent blood routine examination,liver,kidney and heart function examination,electrolyte,blood glucose,peripheral blood plasmodium and Dengue virus antibody detection and imaging examination,and the results were analyzed comprehensively.Results The patient was a 40-year-old male with diarrhea,vomiting and progressive exacerbation 3 days before admission,and with shortness of breath 1 day before.He was hospitalized on September 10,2020.The results showed that platelet count(PLT)was significantly decreased,liver and kidney function was abnormal,myocardial enzyme indexes were abnormally increased,fasting blood glucose(FBG)and random blood glucose were significantly increased,and EHF antibody immunoglobulin M(IgM)detection was positive.The patient was diagnosed as EHF complicated with type 2 diabetes millitus by Western medicine,and was treated with stomach protection,anti-infection,regulation of intestinal flora,nutritional support and correction of electrolyte disorder;the principle of TCM treatment was to transport spleen and remove dampness.The prescription was to clear the intestines and remove dampness.The directional treatment was to dredge meridians and activate collaterals,promote qi and relieve pain.After treatment,the patient's symptoms were significantly improved,PLT returned to normal range,and other indicators were also significantly improved.The patient was discharged on September 17.Conclusions The manifestations of EHF are various,and patients often seek medical treatment with atypical symptoms.When the patients have a history of fever and thrombocytopenia,attention should be paid to the possibility of EHF.We can make a diagnosis by laboratory detection of serum specific EHF antibody IgM combined with medical history and clinical manifestations.In particular,this patient is complicated with type 2 diabetes mellitus,as a result,the situation should be alert.
作者
曾亭亭
刘道利
周伟青
龙华婧
梁涯
高东华
常勇
Zeng Tingting;Liu Daoli;Zhou Weiqing;Long Huajing;Liang Ya;Gao Donghua;Chang Yong(Clinical Laboratory,Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University,Guangzhou 510130,Guangdong,China;Department of Cardiovascular,Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University,Guangzhou 510130,Guangdong,China)
出处
《实用检验医师杂志》
2021年第2期117-119,共3页
Chinese Journal of Clinical Pathologist
关键词
流行性出血热
2型糖尿病
血小板计数
免疫球蛋白M
Epidemic hemorrhagic fever
Type 2 diabetes mellitus
Platelet count
Immunoglobulin M
作者简介
通信作者:曾亭亭,Email:1210612244@qq.com。
