Analysis Of Clinical Features Of Leptospirosis From 2009 To 2011 In Nanchong City And The Dynamic Of IFN-γ、TNF-α、IL-10 Of Serum Of Patients With Leptospirosis

Objective：To investigate the clinical features of leptospirosis that happened inNanchong from 2009 to 2011, and provide a reliable basis for clinical andbasic research.Method：(1) The clinical manifestations such as clinical symptoms and signs, thehepatic function, and the blood routine of 98 patients with leptospirosis,diagnosed by clinical standard and hospitalized in Yilong County people’sHospital and the affiliate hospital of North Sichuan Medical College from2009 to 2011,were collected. The serum of these patients were alsocollected and analyzed.（2）The leptospira in the serum of the patients werecultured. The serum of antibody of leptospira were detected by microscopicagglutination test. The DNA of leptospira was analized by polymerase chainreaction.（3）The data were analyzed with software of SPSS v16.0.（4）Theclinical information of the laboratory-confirmed cases was analyzed.Result： Among the 98 patients, 83 patients were laboratory-confirmed cases,with an average of 54.7±12.39, 48.19% of male, and 51.81% of female.Main clinical manifestations include fever (91.57%), muscle pain (97.59%),weak (95.18%), Headaches (71.08%), anorexia (68.67%), nausea andvomiting (49.4%), conjunctival congestion (46.99%), superficialLymphadenopathy (24.1%), gastrocnemius muscle pain (77.11%), the averageTotal number of peripheral white blood cells is (10.48±4.74) x109/L,neutrophil ratio 90.4(80.90,93.60)%, lymphocytes ratio 5.1(3.10,9.80)%. Thenumber of platelet is 73.5 (32.00, 125.5) x109/L in laboratory test. Among the83 cases, the patients of typhoid grippotypgosa are 39.76%,icterohemorrhagic form (34.94%), pulmonary hemorrhagic form (15.66%),renal failure (3.61%), and meningoencephalitis (6.02%); Mortality is 9.64%.Conclusion：In recent years, the patients with Leptospirosis are older than everbefore, and the early manifestation of patients is different from before: musclepain and weak more frequently and swelling of lymph nodes are lessfrequently than before. Further more, among the clinical types, the proportionof grippotypgosa declined, and the proportion of icterohemorrhagic and theproportion of the pulmonary haemorrhagic increased. So the dieases is moreserious than before, which should be pay more attention. Part two The dynamic of TNF-α, IL-10, IFN-γin serum of patients withLeptospirosisObjectives：To investigate the dynamic of serum TNF-α, IL-10, IFN-γof patientswith Leptospirosis, and provide the scientific basis for clinical and basicresearch.Method：(1)The serum of 24 laboratory-confirmed cases with leptospirosis inNanchong in 2011 were collected and analyzed, with 10 health people fromnon-leptospirosis epidemic area as control. (2)The levels of TNF-α, IL-10,IFN-γwere detected by enzyme-linked immunosorbent assay (ELISA).(3)The levels of TNF-α, IL-10, IFN-γbetween groups of early , middle andlate period were analyzed with the one-way analysis of variance(OnewayANOVA), respectively. The levels of TNF-α, IL-10, IFN-γof early, middleand late period were compared in the SNK way, and the levels of TNF-α,IL-10, IFN-γin serum of patients and control were compared by Dunnett-ttest.Result： (1) The levels of IFN-γof patients in early, middle, late period were allhigher than control (α=0.05, P<0.05), Significan tstatistics difference was notfound in multiple comparison of IFN-γamong Early, middle, late cases(α=0.05,P>0.05). (2) The levels of IL-10 early, middle, late period were allhigher than normal (α=0.05,P<0.05). in multiple comparison, The level ofIL-10 in late period was lower than that of middle period, and the level ofIL-10 in middle period was higher than that of early period (α=0.05,P<0.05) .(3) The level of TNF-αin early and middle period was higher than that ofcontrol group (α=0.05,P<0.05), the difference of the level TNF-αbetween lateperiod and normal human was not statistically significant (α=0.05,P＞0.05),The paired comparison confirmed that, TNF-αlevels of medium-term ishigher than that of early and late period(α=0.05,P<0.05), and the differencebetween early and late was not statistically significant (α=0.05,P>0.05).Conclusion：IFN-γlevel is highly expressed in the whole course, TNF-αlevelincreases at first and then decreases in the course of leptospirosis; The level ofIL-10 is high but decline gradually as the disease progresses, it is suggestedthat IFN-γ, TNF-α, and IL-10 play an important role in the course ofleptospira clearance and process of leptospirosis.