新型布尼亚病毒感染致发热伴血小板减少综合征临床特点及血常规和血清酶学分析  

Study on the clinical characteristics of severe fever with thrombocytopenia syndrome caused by bunyavirus patients and analysis of routine blood and serum enzymology

作　　者：魏艳艳[1] 邹桂舟[1] 叶珺[1] 郜玉峰[1] 夏国美[1] 李芳[1] 金蕾[1] 魏峰[2] 

机构地区：[1]安徽医科大学第二附属医院肝病科,安徽合肥230601 [2]安徽大学经济学院,安徽合肥230062

出　　处：《安徽医药》2016年第5期903-907,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨发热伴血小板减少综合征的流行病学、临床特征，通过血常规和血清酶学动态变化预测重症患者预后。方法对70例发热伴血小板减少综合征病例资料进行回顾性分析，比较痊愈组和死亡组病程中临床表现和实验室检查结果，应用t检验和Spearman分析发现危重症及死亡患者预后相关危险因素。结果患者以中老年农民为主，多在5～7月份发病，17．39％患者有明确蜱叮咬史。14例患者死亡，病死率为20％。症状主要表现为发热、畏寒寒战、全身不适、乏力、肌肉酸痛、纳差、腹泻、恶心、呕吐和头痛及咳嗽咳痰等。体征主要表现脑膜刺激征阳性，颈部、腋窝、腹股沟淋巴结肿大伴触痛阳性。实验室指标异常主要为WBC、PLT降低，ALT、AST、CK、LDH升高。结论发热伴血小板减少综合征临床表现多种多样，常常伴有实验室检测指标明显异常，出现多脏器功能衰竭、神经系统损害、出血倾向及肺部重症感染，甚至感染性休克的患者预后差，死亡率高。在诊疗过程中，宜采取有效对症支持治疗，尤其对重症患者需加强实验室指标的监测和病情监护。Objective To investigate the epidemiological and clinical features in patients with severe fever with thrombocytopenia syndrome( SFTS). Analysing routine blood and serum enzymology predict the prognosis of patients with severe dynamic change. Methods A retrospective study was conducted in 70 SFTS patients with detailed medical records. Comparing healing group and death group in the course of the clinical manifestations and laboratory test results and Using t test and spearman analysis found that the prognosis of patients with severe disease and death related risk factors. Results Old farmers accounted for a large proportion,and the onset of the disease mainly occurred from May to July each year. A history of tick bites was found in 17. 39% of the patients. The major clinical symptoms were fever,chill,general malaise,fatigue,muscle pain,loss of nausea,vomiting,headache,cough and expectoration. The major clinical sign were positive meningeal stimulation,the neck,armpits,groin lymph node enlargement with enlargement and tenderness of superficial lymph node. Laboratory findings were characterized by decrease in WBC,PLT,elevated levels of ALT,AST,CK,LDH. Fourteen patients died,with the fatality rate of 20%. Conclusions The clinical manifestations of the patients with SFTS maybe diverse,usually accompanied by obvious abnormality of biochemical markers. The mortality of patients with multiple organ function failure,nervous system damage,bleeding tendency and severe lung infection,even the poor prognosis of patients with septic shock is high. Supportive treatment should be initiated in clinical practice,especially for intensive need to strengthen the laboratory indicators monitoring and patient care.

关 键 词：布尼亚病毒科感染 血小板减少 疾病特征 

分 类 号：R511[医药卫生—内科学]