发热伴血小板减少综合征和恙虫病患者临床特征和器官损害的差异  

Differences of clinical manifestations and organ damage between patients with severe fever with thrombocytopenia syndrome and patients with tsutsugamushi disease

作　　者：胡立芬[1] 徐方明 夏玲玲[1] 马雪娇[1] 常啸[1] 伍婷 李家斌[1] Hu Lifen;Xu Fangming;Xia Lingling;Ma Xuejiao;Chang Xiao;Wu Ting;Li Jiabin(Department of Infectious Diseases, the First Affiliated Hospital of Anhui Medical University, Hefei 230022 , China)

机构地区：[1]安徽医科大学第一附属医院感染科,合肥230022

出　　处：《中华传染病杂志》2019年第2期82-87,共6页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金(81101313).

摘　　要：目的分析发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome, SFTS)和恙虫病患者临床表现和器官损害的差异,探讨影响预后的因素。方法2014年10月至2017年6月安徽医科大学第一附属医院收治的SFTS患者49例,恙虫病患者16例。评估患者的一般资料(地区、年龄、性别和各种临床表现)。病程中连续监测血常规、肝肾功能、心肌酶谱、脂肪酶、淀粉酶、电解质、C反应蛋白、降钙素原、PT和活化部分凝血活酶时间(activated partial thromboplastin time,APTT)。正态分布的计量资料采用t检验,非正态分布的计量资料采用非参数检验,计数资料采用卡方检验进行统计学分析。结果SFTS患者年龄(62.1±15.5)岁,范围17~87岁;恙虫病患者年龄(56.1±9.2)岁,范围47~73岁;两组年龄差异无统计学意义(t=1.47,P=0.147)。SFTS患者中男性25例(51%),恙虫病患者中男性8例(50%),两组性别构成差异无统计学意义(χ^2=0.005,P=0.943)。SFTS和恙虫病患者头痛呕吐、体表淋巴结肿大、意识障碍、蛋白尿、血尿、肺部感染、多器官功能损伤和急性胰腺炎发生率比较差异均有统计学意义(χ^2值分别为8.82、4.38、8.71、11.17、7.88、5.56、4.35、9.43和8.13,P<0.05或0.01)。SFTS患者白细胞计数(Z=2.73)、中性粒细胞计数(Z=2.46)、淋巴细胞计数(Z=3.15)、血小板计数(Z=4.25)、白蛋白(Z=2.65)和血钠水平(t=2.10)低于恙虫病患者,比较差异均有统计学意义(P<0.05或0.01);AST(Z=2.94)、乳酸脱氢酶[lactate dehydrogenase,LDH(Z=3.42)]、肌酸激酶[creatine kinase,CK(Z=2.88)]、淀粉酶(Z=2.77)、脂肪酶(Z=2.82)、肌酐(Z=2.07)和尿素氮(Z=2.50)较恙虫病患者明显升高,比较差异均有统计学意义(P<0.05或0.01)。SFTS死亡16例,生存33例。死亡组与生存组年龄(t=3.33)、血小板计数(Z=2.55)、ALT(Z=2.10)、AST (Z=2.22)、LDH(Z=2.26)、CK(Z=3.50)、CK-MB (Z=3.10)、肌酐(Z=2.17)、尿素氮(Z=2.36)、血钠(t=2.65)比较差异均有�Objective To analyze the differences of clinical manifestations and organ damage between patients with severe fever with thrombocytopenia syndrome(SFTS) and patients with tsutsugamushi disease, and to investigate the prognostic factors of SFTS. Methods The research was performed on 49 patients with SFTS and 16 patients with tsutsugamushi disease who visited the First Affiliated Hospital of Anhui Medical University from October 2014 to June 2017. The general information of patients including region, age, gender and clinical manifestations were evaluated. Blood routine, liver and kidney function, myocardial enzyme levels, lipase, amylase, electrolytes, C-reactive protein, procalcitonin, prothrombin time(PT) and activated partial thromboplastin time(APTT) were continuously monitored during the course of disease. T test was used for continuous variables of normal distribution, and non-parametric test was used for variables of non-normal distribution. Chi-square test was used for categorical variables. Results The mean age of SFTS patients was 62.1±15.5(ranging from 17 to 87 years) and the mean age of tsutsugamushi patients was 56.1±9.2 (ranging from 47 to 73 years). There was no significant difference between the two groups (t=1.47, P=0.147). There were 25 males(51%) in SFTS patients and 8 males (50%) in tsutsugamushi disease patients. There was no significant difference between the two groups (χ^2=0.005, P=0.943). The incidences of headache, vomiting, superficial lymphadenectasis, disturbance of consciousness, proteinuria, hematuria, pulmonary infection, multiple organ dysfunction and acute pancreatitis in SFTS patients were all significantly higher than those in tsutsugamushi disease patients (χ^2=8.82, 4.38, 8.71, 11.17, 7.88, 5.56, 4.35, 9.43, and 8.13, respectively, P<0.05 or 0.01). The counts of leukocytes (Z=2.73), neutrophils (Z=2.46), lymphocytes (Z=3.15), platelets (Z=4.25), albumin (Z=2.65) and sodium ion (t=2.10) in SFTS patients were all significantly lower than those in patients with tsutsugamushi d

关 键 词：丛林斑疹伤寒 发热伴血小板减少综合征 新型布尼亚病毒 器官损害 

分 类 号：R513.2[医药卫生—内科学] R510[医药卫生—临床医学]