60例儿童肾综合征出血热患者的临床特点及重型高危影响因素  

Clinical characteristics of 60 children with hemorrhagic fever complicated with renal syndrome and the risk factors of severe cases

作　　者：邓慧玲[1] 张玉凤[1] 刘宇阳 张瑜[1] 王小燕[1] 王军[1] 袁娟[1] 余鹏博[2] Deng Huiling;Zhang Yufeng;Liu Yuyang;Zhang Yu;Wang Xiaoyan;Wang Jun;Yuan Juan;Yu Pengbo(Department of Infectious Diseases,Xi’an Children’s Hospital,Xi’an 710003,China;Institute of Virology,Shaanxi Provincial Center for Diseases Control and Prevention,Xi’an 710054,China)

机构地区：[1]西安市儿童医院感染二科,西安市710003 [2]陕西省疾病预防控制中心病毒所,西安市710003

出　　处：《中华实验和临床感染病杂志（电子版）》2018年第2期150-154,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：西安市科学技术局医疗卫生研究项目(No.2016052SF/YX08);陕西省科技统筹创新工程计划项目(重点产业创新链)(No.2016KTZDSF02-04);国家卫生和计划生育委员会公益性行业科研专项项目(No.201502020)

摘　　要：目的分析儿童肾综合征出血热(HFRS)的临床特点及重型病例的危险因素,以指导该病的早识别、早诊断和早治疗。方法选取2010年1月至2016年12月西安市儿童医院临床诊断的儿童肾综合征出血热患儿共60例,分析其临床资料特点,并采用多因素Logistic回归分析明确重型病例的危险因素。结果入组60例患儿临床表现均有发热,且消化道症状发生率高,肾综合征出血热的"三红"、"三痛"典型表现发生率并不高。实验室指标检查显示:入组患儿白蛋白异常、尿蛋白异常、降钙素原、白细胞及血小板计数异常率较高。多因素Logistic回归分析结果显示,PLT<30×109/L(χ~2=34.75、P<0.001)、ALT>500 U/L(χ~2=27.30、P<0.001)、PCT>25 ng/ml(χ~2=8.45、P=0.02)、尿蛋白阳性(χ~2=11.32、P<0.001)和Scr>250μmol/L(χ~2=7.89、P<0.001)共5个影响因素的回归系数与病情严重程度相关,均具有统计学意义。结论儿童肾综合征出血热临床表现不典型,无特异性表现,容易漏诊误诊,临床医师应该提高警惕;PLT、ALT、PCT、Scr显著异常及尿蛋白阳性是重型HFRS的危险因素。Objective To investigate the characteristics of clinical data of children with hemorrhagic fever complicated with renal syndrome and the risk factors of severe cases, and to guide the early identifcation, diagnosis and treatment of the disease. Methods Total of 60 patients with hemorrhagic fever complicated with renal syndrome in Xi’an Children’s Hospital from January 2010 to December 2010 were collected. The clinical data were analyzed and the risk factors of severe cases were analyzed by multivariate Logistic regression. Results The 60 children all had fever, and the incidence rate of gastrointestinal symptoms was high, but the incidence of typical “three red” and “three pain” in children was not high. In laboratory tests, there were high percentage of abnormal albumin, urine protein, procalcitonin, white blood cells and platelet count in 60 cases. Multivariate Logistic regression analysis showed that PLT 〈 30 × 109/L （χ2 = 34.75, P 〈 0.001）, ALT 〉 500 U/L （χ2 = 27.30, P 〈 0.001）, PCT 〉 25 ng/ml （χ2 = 8.45, P = 0.02）, urine protein （χ2 = 11.32, P 〈 0.001）, Scr 〉 250 μmol/L （χ2 = 7.89, P 〈 0.001） were all associated with disease severity, with signifcant differences. Conclusions The clinical manifestations of children hemorrhagic fever complicated with renal syndrome were not typical and specifc, so clinicians should be vigilant. PLT, ALT,PCT, Scr and urinary protein were the risk factors of severe HFRS.

关 键 词：肾综合征出血热 临床特点 重型病例 相关因素 

分 类 号：R512.8[医药卫生—内科学]