辽宁省大连地区发热伴血小板减少综合征临床特征及预后影响因素研究  

Clinical characteristics and influencing factors for prognosis of fever with severe thrombocytopenia syndrome in Dalian,Liaoning Province

作　　者：侯豪华 毛玲玲[2] 梁玉红[3] 刘芸[2] 刘学升[2] 邓宝成[1] HOU Hao-hua;MAO Ling-ling;LIANG Yu-hong;LIU Yun;LIU Xue-sheng;DENG Bao-cheng(Department of Infectious Diseases,The First Affiliated Hospital of China Medical University,Shenyang 110001,China;Liaoning Provincial Center for Disease Control and Prevention,Shenyang 110001,China;Dalian Center for Disease Control and Prevention,Dalian 116021,China)

机构地区：[1]中国医科大学附属第一医院传染科,辽宁沈阳110001 [2]辽宁省疾病预防控制中心,辽宁沈阳110001 [3]大连市疾病预防控制中心,辽宁大连116021

出　　处：《中国感染控制杂志》2021年第10期897-902,共6页Chinese Journal of Infection Control

基　　金：国家十三五重大科技专项(2017ZX10103007-005)。

摘　　要：目的对大连地区发热伴血小板减少综合征(SFTS)患者的临床特征以及影响预后因素进行分析,为早期治疗降低病死率提供依据。方法收集2018—2020年大连市疾病预防控制中心112例SFTS病例,其中存活病例79例,死亡病例33例,分析存活组与死亡组的临床特征、实验室指标,以及影响SFTS患者预后的因素。结果共纳入112例患者,病死率为29.5%。年龄,合并糖尿病、高血压,房颤,住院时间死亡组与存活组相比,差异均具有统计学意义(均P<0.05)。临床症状中死亡组患者早期出现神经症状、出血表现比例高于存活组患者,实验室指标中钙离子、门冬氨酸氨基转移酶、丙氨酸氨基转移酶、乳酸脱氢酶、肌酐、尿素氮水平、凝血酶原时间、凝血酶原活动度、清蛋白、血小板、C-反应蛋白、病毒载量水平,死亡组与存活组比较差异均具有统计学意义(均P<0.05)。多因素logistic回归分析,病毒载量、神经系统症状、出血表现、肌酸激酶>170 U/L可作为预测SFTS患者预后的指标。结论大连地区SFTS患者病死率较高,病毒载量、早期神经系统表现、出血表现和早期肌酸激酶>170 U/L可作为患者预后预测指标。大连地区高病死率的原因是否与病毒株和毒力差异,以及临床治疗差异等相关,需要进一步研究阐明。Objective To analyze the clinical characteristics and influencing factors for prognosis of patients with severe fever with thrombocytopenia syndrome(SFTS)in Dalian,and provide reference for early treatment to reduce mortality.Methods 112 cases of SFTS in Dalian Center for Disease Control and Prevention from 2018 to 2020 were collected,including 79 survival cases and 33 death cases,clinical characteristics,laboratory indicators and prognostic factors of SFTS patients in survival group and death group were analyzed.Results A total of 112 patients were included in analysis,mortality was 29.5%.There were significant difference in age,diabetes mellitus,hypertension,atrial fibrillation,and length of hospital stay between survival group and death group(all P<0.05).In clinical symptoms,the proportion of early neurological symptoms and bleeding in death group was higher than that in survival group;in laboratory indicators,including calcium ion,aspartate aminotransferase,alanine aminotransferase,lactate dehydrogenase,creatinine,urea nitrogen,prothrombin time,prothrombin activity,albumin,platelet,C-reactive protein,and virus load,difference between death group and survival group were all statistically significant(all P<0.05).Multivariate logistic regression analysis showed that viral load,neurological symptoms,bleeding and creatine kinase>170 U/L can be used to predict the prognosis of SFTS patients.Conclusion The mortality of SFTS patients in Dalian is high,viral load,early neurological manifestations,bleeding and early creatine kinase>170 U/L can be used as prognostic indicators.Whether the cause of high mortality of SFTS patients in Dalian is related to the difference of virus strain and virulence,as well as clinical treatment needs to be further studied.

关 键 词：发热伴血小板减少综合征 临床特征 预后因素 

分 类 号：R181.3[医药卫生—流行病学] R511[医药卫生—公共卫生与预防医学]