中国寄生虫学与寄生虫病杂志 ›› 2022, Vol. 40 ›› Issue (3): 379-383.doi: 10.12140/j.issn.1000-7423.2022.03.015

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疟疾患者体内原虫密度与治疗措施调查

李美(), 周何军, 尹建海, 张丽, 涂宏   

  1. 中国疾病预防控制中心寄生虫病预防控制所(国家热带病研究中心),国家卫生健康委员会寄生虫病原与媒介生物学重点实验室,世界卫生组织热带病合作中心,国家级热带病国际联合研究中心,上海 200025
  • 收稿日期:2021-08-20 修回日期:2021-10-17 出版日期:2022-06-30 发布日期:2022-07-06
  • 通讯作者: 李美
  • 作者简介:李美(1976-),女,博士,研究员,从事疟疾原虫学研究。E-mail: limei@nipd.chinacdc.cn

Investigation on parasite density and treatment measures in malaria patients

LI Mei(), ZHOU He-jun, YIN Jian-hai, ZHANG Li, TU Hong   

  1. National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai 200025, China
  • Received:2021-08-20 Revised:2021-10-17 Online:2022-06-30 Published:2022-07-06
  • Contact: LI Mei

摘要:

随机抽检2019年28个省(直辖市、自治区)疟疾患者的血涂片,在粗略估测患者体内原虫密度的基础上,以原虫密度高于4 000虫/μl和/或有并发症作为患者病情严重标准,结合寄生虫病防治信息管理系统中患者的诊疗信息,分析我国疟疾患者临床病情严重程度与患者治疗方式(住院治疗或门诊治疗)和用药方案(针剂注射或口服用药)间的符合性。结果显示,共收集272例患者的血涂片和相关信息,病情较重患者共163例(占59.93%),其中原虫高密度感染者160例,低密度有并发症者3例;当原虫密度较高时,患者倾向于出现并发症(P < 0.05)。在县、地市和省级医疗机构首诊和治疗的疟疾患者数分别占83.82%(228/272)和96.32%(262/272),且均以在地市级医疗机构的数量最多(40.81%,111/272;48.90%,133/272)。患者住院比例为77.94%(212/272),针剂注射治疗比例为57.93%(157/271)。患者接受治疗的总体趋势为给予病情较重者住院治疗(92.02%,150/163),给予病情较轻者门诊治疗(7.98%,13/163)(P < 0.05);县、地市和省三级医疗机构各自治疗疟疾患者的治疗方式的趋势与总趋势一致(P < 0.05)。患者用药方案的总体趋势为病情较重者给予针剂注射治疗(66.67%,108/162),病情较轻者给予口服抗疟药治疗(55.05%,60/109)(χ2 = 12.61,P < 0.05);仅地市级医疗机构的用药情况与总体趋势一致(χ2 = 7.17,P < 0.05),县级和省级医疗机构的这一趋势不明显(χ2 = 0.62、1.36,P > 0.05)。治疗方式和用药方案与病情不相符的患者比例分别为27.53%(75/272)和37.83%(103/272)。提示当前治疗疟疾的主要医疗机构实施的治疗措施总体良好。

关键词: 原虫密度, 针剂注射, 口服抗疟药, 医疗机构, 血涂片

Abstract:

The blood smears and basic information of 272 malaria patients in 28 Provinces (Municipalities and Autonomous regions) in 2019 were randomly selected. According to the rough estimation of the parasite density, patients with parasite density higher than 4 000/μl and/or with complications were defined as in severe conditions. Following the definition and information recorded in the National Information System for Parasitic Disease Prevention and Control, the consistency between conditions of malaria patients and their therapeutic strategies (hospitalization or outpatient treatment) and medication regimens (injection or oral medication). One hundred sixty-three patients were categorized as severe cases, including 160 with high parasite density and 3 with complications but low parasite density. The patients tended to have complications (P < 0.05) with higher parasite density. First visits and treatment of most patients were in County, Prefecture and provincial medical agencies (83.82%, 228/272; 96.32%, 262/272). Patients visited and treated in Prefecture medical agencies were the most (40.81%, 111/272; 48.90%, 133/272) among medical facilities of different levels. The proportion of hospitalized patients was 77.94% (212/272), and the proportion of patients treated with injections was 57.93% (157/271). The general trend was to hospitalize those with severe conditions (92.02%, 150/163), while patients with mild conditions were treated as outpatients (7.98%, 13/163) (χ2 = 46.92, P < 0.05). The trend of treatment methods for malaria patients in the county, prefecture, and provincial tertiary medical institutions was consistent with the general trend (P < 0.05). The overall trend of the patient’s medication regimen was that patients with severe disease were administrated with therapies (66.67%, 108/162), and those with mild disease were administrated with oral antimalarial therapies (55.05%, 60/109) (χ2 = 12.61, P < 0.05). Only the drug use in prefecture-level medical institutions was consistent with the overall trend (χ2 = 7.17, P < 0.05), while the trend in the county and provincial medical institutions was not significant (χ2 = 0.62, 1.36, P > 0.05). The proportion of patients whose treatment and drug regimens were inconsistent with the condition was 27.53% (75/272) and 37.83% (103/272), respectively. The treatment measures implemented by the primary medical facilities for the treatment of malaria are generally good.

Key words: parasite density, Injection, Oral medication, Medical agency, Blood smears

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