发热伴血小板减少综合征临床特征与预后影响因素分析  

The analysis of clinical features and prognosis factors in patients with severe fever with thrombocytopenia syndrome

作　　者：谢许冒 张利娟[2] 刘芬[2] 童巧霞[2] Xie Xumao Zhang Lijuan Liu Fen Tong Qiaoxia(Department of Emergency, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Chin)

机构地区：[1]华中科技大学同济医学院附属协和医院急诊科,武汉430022 [2]华中科技大学同济医学院附属协和医院感染科,武汉430022

出　　处：《中华传染病杂志》2017年第1期31-34,共4页Chinese Journal of Infectious Diseases

摘　　要：目的探讨发热伴血小板减少综合征患者临床指标对疾病发展、预后的影响。方法收集华中科技大学同济医学院附属协和医院感染科2015年4月1日至2015年10月30日住院的发热伴血小板减少综合征患者164例，其中康复136例，死亡28例。对患者临床表现、实验室检查结果等临床资料进行回顾性分析，用Spearman相关分析临床指标与患者预后的相关性，用受试者工作特征曲线下面积分析相关指标预测患者死亡的效能。结果死亡患者平均年龄为（64.5±9.1）岁，高于康复患者的（56.9±10.2）岁，差异有统计学意义（t＝－3.609，P〈0.01）。所有患者均出现白细胞和血小板计数下降，绝大多数患者出现血清钙水平下降，AST、ALT、乳酸脱氢酶（LDH）、CK、活化部分凝血活酶时间（APTT）、D-二聚体水平升高。死亡组患者新型布尼亚病毒核酸为（5.83±0.98） lg TCID50/mL （TCID50为组织培养半数感染剂量），高于康复组患者（3.96±1.08） lg TCID50/mL，差异有统计学意义（t＝－8.49，P〈0.01）。结论年龄、血浆病毒核酸载量、CK、APTT是发热伴血小板减少综合征患者预后的影响因素。Objective To explore the influence of clinical indicators in patients with thrombocytopenia syndrome （SFTS） with severe fever on disease development and prognosis. Methods The SFTS patients who were admitted to the Department of Infection Diseases of Wuhan Union Hospital between April 1, 2015 and October 30, 2015 were included. Among 164 patients with SFTS, there were 136 cases recovered and 28 cases died. Clinical date including clinical manifestations and laboratory test index were collected and retrospectively analyzed. The correlation between the prognosis and clinical indicators were analyzed with the Spearman correlation analysis, the discriminatory power of clinical dates were tested with the area under the receiver-operating characteristic curve. Results The average age of died patients in the study was （64. 5 ± 9. 1）, which increased significantly （t =- 3. 609, P〈 0. 01 ） compared with recovered patients with （56.9±10.2）. Laboratory results suggest all patients had a drop in white blood cell and platelet count; almost all patients had a drop in serum calcium levels, and a rise in aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase （CK）, activated partial thromboplastin time （APTT）, D-dimmer levels. The nucleic acid quantification of SFTSV suggests death patients （5.83±0.98） lg TCID50/mL was significantly higher than the recovered patients （3.96±1.08） lg TCID50/mL, with statistical difference （t= -8.49, P〈0.01）. Conclusions Age, the nucleic acid quantification of SFTSV, CK and APTT are factors can be used to predict prognosis of SFTS.

关 键 词：发热伴血小板减少综合征 新型布尼亚病毒 预后 

分 类 号：R510[医药卫生—内科学]