{"id":8901,"date":"2025-06-12T16:18:42","date_gmt":"2025-06-12T08:18:42","guid":{"rendered":"https:\/\/wp-cc.meddatas.com\/?p=8901"},"modified":"2025-09-16T13:51:00","modified_gmt":"2025-09-16T05:51:00","slug":"20241023-%e7%ac%a6%e7%9a%93%e9%9b%85-a-37-year-old-man-with-fever-myalgiajaundiceand-respiratory-failure-2","status":"publish","type":"post","link":"https:\/\/wp-cc.meddatas.com\/?p=8901","title":{"rendered":"\u3010Case Listen and Say\u30112024-N Engl J Med-A 37-Year-Old Man with Fever, Myalgia,Jaundice,and Respiratory Failure"},"content":{"rendered":"<p style=\"text-align: center;\"><strong>\u6c47\u62a5\u4eba\uff1a\u7b26\u7693\u96c5\uff1b\u6c47\u62a5\u65f6\u95f4\uff1a2024.10.23<\/strong><\/p>\n<p><img loading=\"lazy\" class=\" wp-image-8902 aligncenter\" src=\"https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u7b26\u7693\u96c5.jpg\" alt=\"\" width=\"686\" height=\"325\" srcset=\"https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u7b26\u7693\u96c5.jpg 1646w, https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u7b26\u7693\u96c5-300x142.jpg 300w, https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u7b26\u7693\u96c5-1024x485.jpg 1024w, https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u7b26\u7693\u96c5-768x364.jpg 768w, https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u7b26\u7693\u96c5-1536x728.jpg 1536w\" sizes=\"(max-width: 686px) 100vw, 686px\" \/><\/p>\n<p style=\"text-align: center;\"><strong><b>Case 23-2024: <\/b><\/strong><strong><b>A 37-Year-Old Man with Fever, Myalgia,Jaundice,and Respiratory Failure<\/b><\/strong><\/p>\n<p style=\"text-align: center;\"><strong><b>N Engl J Med 2024;391:1343-54.\uff08<\/b><\/strong><strong><b>DOI: <\/b><\/strong><strong><b>10.1056\/NEJMcpc2402493\uff09<\/b><\/strong><\/p>\n<ul>\n<li><b><\/b><strong><b>\u4e3b\u8bc9\u4e0e\u73b0\u75c5\u53f2<\/b><\/strong><\/li>\n<\/ul>\n<p>\u60a3\u8005\u4e3a37\u5c81\u9752\u5e74\u7537\u6027\uff0c\u56e0\u201c\u53d1\u70ed\u3001\u808c\u75db\u3001\u9ec4\u75b8\u548c\u4f4e\u6c27\u8840\u75c79\u5929\u201d\u5165\u9662\u30029\u5929\u524d\u60a3\u8005\u51fa\u73b0\u4e0d\u9002\u3001\u75b2\u52b3\u548c\u5168\u8eab\u65e0\u529b\uff0c\u968f\u540e\u51fa\u73b0\u9ad8\u70ed\u3001\u5934\u75db\u3001\u808c\u8089\u9178\u75db\u548c\u98df\u6b32\u4e0d\u632f\u30025\u5929\u524d\u53d1\u70ed\u548c\u5934\u75db\u6709\u6240\u7f13\u89e3\uff0c\u4f46\u808c\u8089\u9178\u75db\u52a0\u91cd\uff0c\u5c3f\u6db2\u5448\u6df1\u9ec4\u8272\u30023\u5929\u524d\u60a3\u8005\u5728\u5176\u4ed6\u533b\u9662\u7684\u6025\u8bca\u8bca\u6240\u5c31\u8bca\uff0c\u6392\u9664\u4e86SARS-CoV-2\u3001\u547c\u5438\u9053\u5408\u80de\u75c5\u6bd2\u548c\u6d41\u611f\u75c5\u6bd2\u3002\u5165\u9662\u524d2\u5929\uff0c\u60a3\u8005\u51fa\u73b0\u9ec4\u75b8\uff0c\u88ab\u5efa\u8bae\u8f6c\u81f3\u6025\u8bca\u79d1\u3002<\/p>\n<ul>\n<li><b><\/b><strong><b>\u65e2\u5f80\u53f2\u4e0e\u4e2a\u4eba\u53f2<\/b><\/strong><b><\/b><\/li>\n<\/ul>\n<ol>\n<li>\u65e2\u5f80\u4f53\u5065\uff0c\u65e0\u57fa\u7840\u75be\u75c5\uff0c\u65e0\u836f\u7269\u8fc7\u654f\u3002<\/li>\n<li>\u65c5\u5c45\u53f2\uff1a\u4f4f\u5728\u65b0\u82f1\u683c\u5170\u5e02\u533a\u7684\u516c\u5bd3\uff0c\u6bcf\u5929\u5728\u6811\u6797\u6cb3\u8fb9\u905b\u72d7\uff0c\u8fc7\u7a0b\u4e2d\u591a\u6b21\u88ab\u6606\u866b\u53ee\u54ac\u3002\u8fd1\u671f\u65e0\u65c5\u6e38\u53f2\u3002<\/li>\n<li>\u5438\u70df\u53f2\uff1a\u5438\u70df16 \u5e74\uff0c1\u5305\/\u5929\uff0c\u6bcf\u5929\u90fd\u4f7f\u7528\u5927\u9ebb\u3002<\/li>\n<li>\u5bb6\u65cf\u53f2\uff1a\u65e0\u7279\u6b8a\u3002<\/li>\n<\/ol>\n<ul>\n<li><b><\/b><strong><b>\u4f53\u683c\u68c0\u67e5 <\/b><\/strong><\/li>\n<\/ul>\n<ol>\n<li>\u751f\u547d\u4f53\u5f81\uff1a\u5165\u9662\u65f6\uff0cT 36.8\u00b0C\uff0cBP 106\/70 mmHg\uff0cHR 109 \u6b21\/\u5206\uff0cRR 18 \u6b21\/\u5206\uff0cSpO2 100%\uff08\u7a7a\u6c14\uff09\u3002 \u5165\u9662\u7b2c4\u5929\uff0cT 36.3\u00b0C\uff0cBP 100\/56 mmHg\uff0cHR103 \u6b21\/\u5206\uff0cRR 42\u6b21\/\u5206\uff0cSpO2 91%(\u9f3b\u5bfc\u7ba1\u5438\u6c27)\u3002<\/li>\n<li>\u4e13\u79d1\u67e5\u4f53\uff1a\u53cc\u80ba\u53ef\u95fb\u53ca\u5f25\u6f2b\u6027\u5570\u97f3\uff0c\u65e0\u8179\u90e8\u538b\u75db\u3001\u809d\u813e\u80bf\u5927\u3001\u6251\u7ffc\u6837\u9707\u98a4\u6216\u817f\u90e8\u80bf\u80c0\u3002\u5b58\u5728\u660e\u663e\u7684\u5de9\u819c\u548c\u76ae\u80a4\u9ec4\u67d3\uff0c\u65e0\u7ed3\u819c\u5145\u8840\u3001\u76ae\u75b9\u6216\u6e83\u75a1\u3002<\/li>\n<\/ol>\n<ul>\n<li><b><\/b><strong><b>\u8f85\u52a9\u68c0\u67e5 <\/b><\/strong><\/li>\n<\/ul>\n<p>1\u3001\u5f71\u50cf\u5b66<\/p>\n<p>1\uff09\u8179\u90e8\u8d85\u58f0\u68c0\u67e5\u663e\u793a\u9ad8\u56de\u58f0\u548c\u7a81\u51fa\u7684\u95e8\u9759\u8109\u4e09\u8054\u5f81\uff0c\u5177\u6709\u201c\u661f\u7a7a\u201d\u8868\u73b0;\u65e0\u80c6\u7ba1\u6269\u5f20\u6216\u80be\u79ef\u6c34\u3002<\/p>\n<p>2\uff09\u80f8\u8179\u76c6\uff08CT\uff09\u793a\u591a\u7076\u6027\u5b9e\u53d8\u548c\u78e8\u73bb\u7483\u5f71\uff0c\u53cc\u80ba\u5448\u6811\u82bd\u72b6\u7ed3\u8282\uff0c\u53ca\u5c11\u91cf\u80f8\u8154\u79ef\u6db2\u548c\u7eb5\u9694\u548c\u80ba\u95e8\u6dcb\u5df4\u7ed3\u80bf\u5927\u3002<\/p>\n<p>2\u3001\u5b9e\u9a8c\u5ba4\u68c0\u67e5<\/p>\n<p>1\uff09\u8840\u7ec6\u80de\uff1a\u767d\u7ec6\u80de\u8ba1\u6570\uff1a2.1\u4e07\/\u03bcL\uff0c\u8840\u5c0f\u677f\u8ba1\u6570\uff1a6.7\u4e07\/\u03bcL\uff0c\u8840\u7ea2\u86cb\u767d\uff1a10.2g\/dl\u3002<\/p>\n<p>2\uff09\u751f\u5316\u3001\u7535\u89e3\u8d28\uff1a\u808c\u9150\uff1a3.36 mg\/dl\uff0c\u603b\u80c6\u7ea2\u7d20\uff1a26.1 mg\/dl\uff0c\u76f4\u63a5\u80c6\u7ea2\u7d20\uff1a26.1 mg\/dl\uff0c\u94a0\uff1ammol\/l\uff0c\u809d\u9176\u6307\u6807\u672a\u89c1\u660e\u663e\u5f02\u5e38\u3002<\/p>\n<p>3\uff09\u8840\u6e05\u5b66\uff1a\u94a9\u7aef\u87ba\u65cb\u4f53IgM\u6297\u4f53\u9633\u6027\uff08\u9176\u8054\u514d\u75ab\u5438\u9644\u8bd5\u9a8c\uff09\u3002<\/p>\n<p>4\uff09\u5206\u5b50\u68c0\u6d4b\uff1a\u8840\u6db2\u6838\u9178\u6269\u589e\u8bd5\u9a8c\uff08NAAT\uff09\u68c0\u51fa\u81f4\u75c5\u6027\u94a9\u7aef\u87ba\u65cb\u4f53\uff08\u9776\u5411LipL32\u57fa\u56e0\uff09\uff0c\u5c3f\u6db2NAAT\u9634\u6027\u3002<\/p>\n<p>3\u3001\u75c5\u7406<\/p>\n<p>1\uff09\u809d\u6d3b\u68c0\uff1a\u95e8\u8109\u533a\u6df7\u5408\u708e\u75c7\u53cd\u5e94\uff0c\u4f46\u672a\u76f4\u63a5\u68c0\u51fa\u87ba\u65cb\u4f53\u3002<\/p>\n<ul>\n<li><b><\/b><strong><b>\u9274\u522b\u8bca\u65ad\u4e0e\u8bca\u65ad\u601d\u8def<\/b><\/strong><b><\/b><\/li>\n<\/ul>\n<p>\u60a3\u8005\u8be5\u60a3\u8005\u8d77\u75c5\u6025\u3001\u65e2\u5f80\u4f53\u5065\u3001\u65e0\u7279\u5f02\u6027\u75c5\u53f2\uff0c\u9700\u4f18\u5148\u6392\u9664\u4ee5\u4e0b\u75c5\u56e0\uff1a<\/p>\n<ol>\n<li>\u975e\u611f\u67d3\u6027\u75be\u75c5<\/li>\n<\/ol>\n<p>a.\u652f\u6301\u70b9\uff1a\u65e0\u5178\u578b\u75c7\u72b6\u4f53\u5f81\uff0c\u767d\u7ec6\u80de\u589e\u591a\u3001\u6025\u6027\u80be\u8870\u7aed\u548c\u7ed3\u5408\u578b\u9ad8\u80c6\u7ea2\u7d20\u8840\u75c7\u3002<\/p>\n<p>b.\u77db\u76fe\u70b9\uff1a\u767d\u7ec6\u80de\u5206\u7c7b\u8ba1\u6570\u6216\u539f\u59cb\u7ec6\u80de\u65e0\u4e25\u91cd\u5f02\u5e38\uff0c\u5f71\u50cf\u5b66\u4ec5\u6709\u8f7b\u5ea6\u6dcb\u5df4\u7ed3\u80bf\u5927\uff0c\u80ba\u90e8CT\u65e0\u7279\u5f02\u6027\u5f81\u8c61\u3002<\/p>\n<ol start=\"2\">\n<li>\u611f\u67d3\u6027\u75be\u75c5<\/li>\n<\/ol>\n<p>a.\u652f\u6301\u70b9\uff1a\u6025\u6027\u975e\u7279\u5f02\u6027\u53d1\u70ed\u7efc\u5408\u5f81\uff0c\u6606\u866b\u53ee\u54ac\u53f2\uff0c\u767d\u7ec6\u80de\u589e\u591a\u3001\u808c\u9150\u5347\u9ad8\u3001\u7ed3\u5408\u578b\u9ad8\u80c6\u7ea2\u7d20\u8840\u75c7\u7b49\u591a\u9879\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u5f02\u5e38\u3002<\/p>\n<p>1\uff09\u8731\u866b\u75c5<\/p>\n<p>b.\u77db\u76fe\u70b9\uff1a\u809d\u9176\u6307\u6807\u65e0\u660e\u663e\u5f02\u5e38\uff0c\u7ed3\u5408\u578b\u9ad8\u80c6\u7ea2\u7d20\u8840\u75c7\uff0c\u65e0\u76ae\u75b9\u3002<\/p>\n<p>2\uff09\u771f\u83cc\u611f\u67d3<\/p>\n<p>\u6392\u9664\u70b9\uff1a\u65e0\u75ab\u533a\u65c5\u5c45\u53f2\uff0c\u5f71\u50cf\u5b66\u65e0\u7279\u5f02\u8868\u73b0\u3002<\/p>\n<p>3\uff09\u75c5\u6bd2\u611f\u67d3\uff08EB\u75c5\u6bd2\u3001\u5de8\u7ec6\u80de\u75c5\u6bd2\u3001HIV\u75c5\u6bd2\uff09<\/p>\n<p>\u6392\u9664\u70b9\uff1a\u65e0\u514d\u75ab\u6291\u5236\u75be\u75c5\uff0c\u65e0\u9ad8\u80c6\u7ea2\u7d20\u8840\u75c7\u3002<\/p>\n<ol start=\"3\">\n<li>\u7ed3\u5408\u578b\u9ad8\u80c6\u7ea2\u7d20\u8840\u75c7<\/li>\n<\/ol>\n<p>\u6392\u9664\u70b9\uff1a\u591a\u4e3a\u5148\u5929\u75be\u75c5\u3001\u4e0e\u80c6\u6c41\u6de4\u79ef\u6709\u5173\u3002<\/p>\n<ul>\n<li><b><\/b><strong><b>\u6700\u7ec8\u8bca\u65ad<\/b><\/strong><\/li>\n<\/ul>\n<p>\u9ec4\u75b8\u578b\u94a9\u7aef\u87ba\u65cb\u4f53\u75c5\uff08Icteric leptospirosis\uff09\u3002<\/p>\n<ul>\n<li><b><\/b><strong><b>\u6cbb\u7597\u4e0e\u9884\u540e<\/b><\/strong><\/li>\n<\/ul>\n<p>\u6cbb\u7597<\/p>\n<ol>\n<li>\u6297\u611f\u67d3\u6cbb\u7597\uff1a\u9759\u8109\u591a\u897f\u73af\u7d20\uff0814\u5929\uff09\u3002<\/li>\n<li>\u652f\u6301\u6cbb\u7597\uff1a\u65e0\u521b\u901a\u6c14\u6cbb\u7597\u53ca\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\u3002<\/li>\n<\/ol>\n<p>\u9884\u540e<\/p>\n<p>\u8be5\u60a3\u80052\u4e2a\u6708\u5185\u9ec4\u75b8\u53ca\u80be\u529f\u80fd\u5b8c\u5168\u6062\u590d\uff0c\u4f4611\u4e2a\u6708\u540e\u4ecd\u5b58\u5728\u521b\u4f24\u540e\u5fc3\u7406\u969c\u788d\u3002\u3002<\/p>\n<ul>\n<li><b><\/b><strong><b>\u603b\u7ed3<\/b><\/strong><b><\/b><\/li>\n<\/ul>\n<p>\u672c\u75c5\u4f8b\u51f8\u663e\u4e86\u94a9\u7aef\u87ba\u65cb\u4f53\u75c5\u5728\u975e\u70ed\u5e26\u5730\u533a\u7684\u7f55\u89c1\u6027\u4e0e\u4e34\u5e8a\u590d\u6742\u6027\u3002\u65e9\u671f\u8bc6\u522b\u6d41\u884c\u75c5\u5b66\u53f2\uff08\u52a8\u7269\u63a5\u89e6\u3001\u6de1\u6c34\u66b4\u9732\uff09\u53ca\u7279\u5f81\u6027\u5b9e\u9a8c\u5ba4\u5f02\u5e38\uff08\u5b64\u7acb\u6027\u7ed3\u5408\u80c6\u7ea2\u7d20\u5347\u9ad8\u3001\u8840\u5c0f\u677f\u51cf\u5c11\uff09\u662f\u8bca\u65ad\u5173\u952e\u3002\u591a\u897f\u73af\u7d20\u8054\u5408\u652f\u6301\u6cbb\u7597\u53ef\u6709\u6548\u6539\u5584\u9884\u540e\uff0c\u4f46\u9700\u5173\u6ce8\u957f\u671f\u5fc3\u7406\u540e\u9057\u75c7\u3002<\/p>\n<p>\u64b0\u7a3f\u4eba\uff1a\u7b26\u7693\u96c5<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u6c47\u62a5\u4eba\uff1a\u7b26\u7693\u96c5\uff1b\u6c47\u62a5\u65f6\u95f4\uff1a2024.10.23 Case 23-2024: A 37-Year-Old Man &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/wp-cc.meddatas.com\/?p=8901\"> <span class=\"screen-reader-text\">\u3010Case Listen and Say\u30112024-N Engl J Med-A 37-Year-Old Man with Fever, Myalgia,Jaundice,and Respiratory Failure<\/span> \u67e5\u770b\u5168\u6587 &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[131],"tags":[],"_links":{"self":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts\/8901"}],"collection":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8901"}],"version-history":[{"count":2,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts\/8901\/revisions"}],"predecessor-version":[{"id":9039,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts\/8901\/revisions\/9039"}],"wp:attachment":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8901"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8901"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8901"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}