高新型布尼亚病毒载量发热伴血小板减少综合征患者141例的临床特征及预后影响因素分析  

Clinical characteristics and prognosis factors of 141 severe fever with thrombocytopenia syndrome cases with high novel Bunya viral load

作　　者：周麟玲 贾荣娟 董崇林 于军华 林勇 常爱娜 黄德瑜 Zhou Linling;Jia Rongjuan;Dong Chonglin;Yu Junhua;Lin Yong;Chang Aina;Huang Deyu(Department of Infectious Diseases,Weihai Central Hospital,Weihai City 264400,Shandong Province,China;Department of Infectious Disease Control and Prevention,Wendeng District Center for Disease Control and Prevention,Weihai City,Shandong Province 264400,China)

机构地区：[1]威海市中心医院感染性疾病科,山东省264400 [2]山东省威海市文登区疾病预防控制中心传染病防制科,264400

出　　处：《中华传染病杂志》2020年第9期578-583,共6页Chinese Journal of Infectious Diseases

基　　金：山东省重点研发计划项目(2018GGX109002)。

摘　　要：目的分析高新型布尼亚病毒载量发热伴血小板减少综合征患者的临床特征及其预后影响因素。方法收集2013年5月20日至2019年10月30日于威海市中心医院经实验室确诊的新型布尼亚病毒RNA≥1×104拷贝/mL的141例发热伴血小板减少综合征住院患者的临床资料,并进行回顾性分析。按照预后分为生存组和死亡组,对比分析其临床表现、实验室检查结果和病毒载量对病情的影响及其预后影响因素。统计学分析采用χ2检验、秩和检验和logistic回归分析。结果生存组76例,中位年龄为64岁;死亡组65例,中位年龄为71岁。生存组和死亡组在神经系统损伤、昏迷、出血、心房颤动伴快速心室率、肾损伤中的差异均有统计学意义(χ2=16.45、64.06、11.25、6.98、33.80,均P<0.01)。生存组和死亡组活化部分凝血活酶时间、天冬氨酸转氨酶、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、羟丁酸脱氢酶、肌酐、血小板计数差异均有统计学意义(Z=6.33、4.51、2.93、4.65、5.00、4.93、5.36、-4.34,均P<0.01)。138例新型布尼亚病毒RNA定量在1.06×104~6.53×107拷贝/mL,3例≥1.00×108拷贝/mL,生存组和死亡组病毒载量分别为4.63(4.32,5.22)和5.29(4.92,6.17)lg拷贝/mL,差异有统计学意义(Z=4.91,P<0.01)。病毒载量为1.00×104~<1.00×105拷贝/mL患者的病死率为29.33%(22/75);病毒载量为1.00×105~<1.00×106拷贝/mL患者的病死率为51.28%(20/39);病毒载量为1.00×106~<1×107拷贝/mL患者的病死率为80.95%(17/21),病毒载量≥1.00×107拷贝/mL的6例患者均死亡。logistic回归分析显示,患者年龄≥60岁,病毒载量>1.00×106拷贝/mL,血小板计数<30.00×109/L,乳酸脱氢酶≥5000.00 U/L,活化部分凝血活酶时间≥84.00 s时,患者的死亡风险增加。结论昏迷、出血、心房颤动伴快速心室率、肾损伤等并发症的发生提示患者病情较重,死亡风险更高。患者年龄、病毒载量、血小板计数、乳酸脱�Objective To analyze the clinical characteristics and prognostic factors of severe fever with thrombocytopenia syndrome patients with high novel Bunya viral load.Methods The clinical data of 141 patients with severe fever with thrombocytopenia syndrome whose viral load higher than 1×104 copies/mL were retrospectively collected from May 20,2013 to October 30,2019 in Weihai Central Hospital.All patients were diagnosed by laboratory tests.According to the prognosis,the cases were divided into survival group and death group.The clinical manifestations,laboratory test results and the influence of viral load on the conditions and the risk factors of prognosis were compared and analyzed.Chi-square test,rank sum test and logistic regression analysis were used for statistical analysis.Results There were 76 patients in survival group,with a median age of 64 years.There were 65 patients in death group,with a median age of 71 years.There were significant differences in neurological injury,coma,hemorrhage,atrial fibrillation with rapid ventricular rate,and renal injury between the survival group and the death group(χ2=16.45,64.06,11.25,6.98 and 33.80,respectively,all P<0.01).There were significant differences in activated partial thromboplastin time(APTT),aspartate aminotransferase(AST),creatine kinase(CK),creatine kinase isoenzymes(CK-MB),lactic acid dehydrogenase(LDH),hydroxybutyrate dehydrogenase(HBDH),creatinine,and platelet count between the survival group and the death group(Z=6.33,4.51,2.93,4.65,5.00,4.93,5.36 and-4.34,respectively,all P<0.01).The RNA quantification of viral load in 138 cases ranged from 1.06×104 to 6.53×107 copies/mL,and the remaining three cases were higher than 1.00×108 copies/mL.The viral load of the two groups were 4.63(4.32,5.22)and 5.29(4.92,6.17)lg copies/mL,respectively(Z=4.91,P<0.01).The mortalities of patients with viral loads of 1.00×104-<1.00×105 copies/mL,1.00×105-<1.00×106 copies/mL and 1.00×106-<1.00×107 copies/mL were 29.33%(22/75),51.28%(20/39),80.95%(17/21),respectively.Si

关 键 词：新型布尼亚病毒 病毒载量 临床特征 预后 

分 类 号：R512.99[医药卫生—内科学]