摘要
目的寨卡病毒病是由寨卡病毒通过伊蚊叮咬传播的急性传染病。报告中国首例输入性寨卡病毒病患者的诊治经过，探讨中西医结合的治疗作用。方法江西省赣县人民医院于2016年2月6日收治了中国首例输入性寨卡病毒病患者，经过9d的隔离治疗痊愈出院。介绍临床诊治过程，分析中药喜炎平注射液的抗病毒作用。结果患者男性，34岁，因“发热9d，眼眶痛、皮疹伴瘙痒4d”于2016年2月6日入院。①流行病学特征：1月1日患者前往委内瑞拉出差，期间常被蚊虫叮咬，当地正在流行寨卡病毒病。委内瑞拉当地时间1月20日患者曾出现头晕，无发热，自行购药（具体不详）服用后症状消失；1月28日稍感头晕、畏寒、低热，呈阵发性发作，无肌肉酸痛；2月3日颈部出现散在细小红色皮疹，随后蔓延到前胸、四肢、躯干，仍有低热、乏力、恶心，耳后、眼眶开始出现阵发性针刺样疼痛，期间一直未治疗；2月4日上述症状逐渐好转减轻。北京时间2月5日患者回到赣县后解黄色稀便3次，体温正常，颈部仍有散在皮疹，无腹痛；2月6日在赣县人民医院诊治。②临床表现：入院体温36．8℃，脉搏80次／min，呼吸频率20次／rain，血压110／70mmHg（1mmHg=0．133kPa），颈前区有散在淡红色细小皮疹，全身浅表淋巴结无肿大，双侧眼结膜充血明显，生理反射存在，病理反射未引出。⑧辅助检查：2月6日查血常规正常，活化部分凝血活酶时间（Ar,＇rr）轻度延长（38．6s），肝肾功能、心肌酶谱、电解质、血糖、C-反应蛋白（CRP）、肌钙蛋白I（TnI）、降钙素原（PCT）均正常。2月8日胸部CT示左肺絮状阴影，结合发热病史，考虑炎性变和轻度肺气肿改变（左下肺为主）；双肾结石。心电图及肝、脾、胰B超均未见明显异常。④病毒检测确诊过程：2月6日赣州市疾病控制中心（CDC）检测结果为登革病毒核酸阴性。2月7日江西省CDC检测结果为寨卡病毒核酸阳性。2月9日中国CDC检测结果为寨卡病毒核酸阳性。首次确诊后对密切接触者予以医学监测。⑤诊疗经过：2月6日收入隔离病房后给予对症治疗及每日静脉滴注1次喜炎平注射液250mg抗病毒治疗。2月7目无发热，偶有畏寒，颈部皮疹消失，眼眶痛好转，双侧眼结膜充血范围缩小变淡，全身黏膜未见溃疡；16：00体温37．5℃，口服布洛芬0．2g，每日3次。2月8日无发热，畏寒明显减轻，无肌肉酸痛和皮疹，眼眶痛及眼结膜充血进一步好转。2月9日双侧眼角稍感刺痛，眼角结膜少量充血，无发热、畏寒，因医院无重组人干扰素α滴眼液贮备，故改用氯霉素滴眼液每日2次。2月11日以后患者无不适感觉，2月13日江西省CDC和中国CDC均回报患者血、尿寨卡病毒核酸阴性，符合出院条件，患者于2月14日痊愈出院。结论目前寨卡病毒病尚无特殊药物可以预防和治疗，本例患者经过9d对症治疗及中药喜炎平注射液抗病毒治疗后症状消失，血、尿寨卡病毒核酸连续检测阴性，痊愈出院。提示中西医结合治疗寨卡病毒病有一定优势。
Objective Zika virus disease is an acute infectious disease caused by Zika virus transmitted through Aedes mosquitoes. To explore the therapeutic effect of integrated traditional Chinese and Western Medicine for Zika virus disease, the treatment process of the first imported case in China was reviewed. Methods The first imported Zika virus disease in China was admitted to Ganxian People＇s Hospital in Jiangxi Province on February 6th, 2016, and the patient received isolation treatment for 9 days and cured later. The effect of antiviral treatments including Xiyanping injection was evaluated based on clinical diagnosis and treatment process of the patient. Results A 34-year old male patient was admitted with chief complaint of fever for 9 days, orbital pain and itching rash for 4 days on February 6th, 2016. （!） Epidemiological characteristics： the patient was bitted by mosquitoes during his business trip in Venezuela since January 1st, where Zika virus disease was ~preading. On January 20th he had dizziness without fever, and the symptom disappeared after taking medicines without details. Paroxysmal dizziness, chills and mild fever without myalgia was experienced on January 28th. On February 3rd small red rash appeared in the neck, spreading to anterior part of chest, limbs and trunk, and the fever, fatigue, nausea was continued, and a new symptom of paroxysmal pain in back of ears and orbits appeared, during which he had not go to hospital. The symptoms relieved on February 4th. He returned to Ganxian County on February 5th, he had yellow stool 3 times with normal temperature, without abdominal pain, and red rash still appeared in the neck. He went to Ganxian People＇s Hospital on February 6th, 2016. （1） Clinical manifestation： the vital signs showed a temperature of 36.8 ℃ , a pulse rate of 80 bpm, a respiratory rate of 20 bpm, and a blood pressure of 110/70 mmHg （1mmHg = 0.133 kPa）. It was showed by physical examination that red rash appeared in the neck, and no superficial enlarged lymph nodes were found. Bilateral conjunctival congestion was obvious, physiological reflex existed and pathological reflex was not found.（2） Auxiliary lab test and examination： no abnormal finding were revealed throughout examination and laboratory tests, including routine blood test, liver function, renal function, serμm myocardial enzyme, electrolyte, blood sugar, C-reactive protein （CRP）, troponin I （TnI）, and procalcitonin （PCT）, except slight prolongation in activated partial thromboplastin time （APT＇F, 38.6 s） on February 6th; and slightly dense shadow in left lung in lung CT scan, considering inflammatory changes and slight emphysema （especially in the left lower lung） as well as bilateral renal calculus on February 8th. No significant abnormalities were found in electrocardiogram and B ultrasound test of liver, spleen, and pancreas. （1） Virus confirmation： Zika virus nucleic acid was positive reported by Jiangxi Province Center for Disease Control and Prevention （CDC） on February 7th and Chinese CDC on February 9th, respectively, though Dengue virus were negative reported by Ganzhou CDC on February 6th. Right after the first diagnosis, anyone who had been in close contact with the patient received medical monitoring. （2）Treatment process： on February 6th, symptomatic treatment was prescribed since admitted into the infectious isolation wards and daily intravenous drip of Xiyanping injection 250 mg was prescribed for antiviral therapy. On February 7th, the patient had no fever, with occasional chills, neck rash was disappeared, orbital pain relieved and bilateral conjunctival hyperemia range was paler and narrowed, and his condition improved. Ibuprofen was administered for defervesce 3 times a day when his temperature reached to 37.5 ℃ at 16：00. On February 8th, the patient had no fever, times of chills was significantly reduced, without myalgia and rash, orbital pain and conjunctival hyperemia further recovered. On February 9th, bilateral eyes slightly tingling, mild conjunctival congestion, no fever chilis or other discomfort was found. The chloramphenicol eye drops was prescribed for relieving sting pain with conjunctival congestion twice a day as recombinant hμman interferon alpha eye drops was out of store. The patient was comfortable from February 1 lth to February 13th. Blood and urine test for Zika were reported negative by the Chinese CDC and Jiangxi Province CDC. Because all the discharge criteria were satisfied, the patient was discharged on February 14th. Conclusions At present, there is no specific effective drug to prevent and treat Zika virus disease effectually. After receiving symptomatic treatment and antiviral treatments including Xiyanping injection, the patient＇s symptoms were relieved. Zika virus nucleic acid in blood and urine was negative. The patient was discharged. Combination of traditional Chinese medicine and Western medicine maybe a good method to prevent and treat Zika virus disease.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2016年第2期106-109,共4页
Chinese Critical Care Medicine
关键词
寨卡病毒病
喜炎平注射液
中西医结合治疗
Zika virus
Treatment of traditional Chinese medicine and Western medicine
Xiyanpinginjection
