쯔쯔가무시병 환자에서의 장내 단백 상실 = Intestinal Protein Loss in Patients with Tsutsugamushi Disease

다국어 초록 (Multilingual Abstract)

Objectives: Tsutsugamushi disease is an acute, febrile illness of humans that is caused by Rickettsia tsutsugamushi. Hypoalbuminemia was reported in some cases of tsutsugamushi disease, but its frequcncy and etiology were not clarified. Therefore we prospectively evaluated fourteen cases of Tsutsugamushi disease patients to idendify intestinal protein loss as a cause of hypoalbuminemia and to assess the value of 99mTc-HSA abdominal scintigraphy for detecting intestinal protein loss. Methods: From November 1994 to December 1994, in fourteen patients with tsutsugamushi disease, serum albumin level and fecal a-1-antitrysin excretion were measured at admission. Anterior abdominal images were obtained at 2, 4, and 24hours after intravenous injection of 30 mCi of Tc-Human serum albumin. Results: 1) The age distribution was mainly in the forties, and fifties. Geographically, 10 cases in the northern part of Kyung-Ki Do and 4 cases in Seoul were occurred. 2) Laboratory findings showed hypoalbuminemia in 5 cases(35.7%), elevated AST and ALT in 11 cases (78.6%), prolonged prothrombin time in 1 cases (7.1%), and proteinuria(30mg/dl) in 9 cases(64.3%). 3) Fecal a-1-antitrypsin concentration was measured in 10 cases of 14 patients with tsutsugamushi disease, of which 8 cases revealed abnormally elevated concentration of fecal a-l-antitrypsin(2.6mg/g dry weight). 4) 99mTc-HSA scintigraphy was positive in 11 of 1478.696) patients with tsutsugamushi disease. 5) In patients with positive 99mTc-HSA scintigraphy, protein loss sites were small bowel(6/11, 54.5%), descending colon(3/14, 27.3%), ascending colon(2/11, 18.1%). Conclusion: Intestinal protein loss was idendified in some patients with tsutsugamushi disease by the measurement of fecal a-1-antitrpysin concentration. 99mTc-HSA scintigraphy is easy and readily available study for detecting intestinal protein loss sites. The comparison of the severity of intestinal protein loss before and after treatment is recommended in patients with tsutsugarnushi disease who have abnormal intestinal protein loss.