肾综合征出血热患者常规实验室指标的动态变化分析与预测价值评估  

Dynamic changes and predictive values of routine laboratory parameters in patients with hemorrhagic fever with renal syndrome

作　　者：詹家燚 杜虹 胡海峰 李孝锋 胡飞 李佳玉 梁燕 石红妍 张凯玄 纪泛扑[2] 连建奇 Zhan Jiayi;Du Hong;Hu Haifeng;Li Xiaofeng;Hu Fei;Li Jiayu;Liang Yan;Shi Hongyan;Zhang Kaixuan;Ji Fanpu;Lian Jianqi(Center for Infectious Diseases,The Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China;Department of Infectious Diseases,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]空军军医大学第二附属医院传染科,西安710038 [2]西安交通大学第二附属医院感染科,西安710004

出　　处：《中华传染病杂志》2023年第2期128-136,共9页Chinese Journal of Infectious Diseases

基　　金：陕西省卫生健康重点支持项目(2022A011);空军军医大学第二附属医院科技创新发展基金临床研究重点项目(2019LCYJ002);空军军医大学临床研究常规项目(2021LC2222)。

摘　　要：目的探究常规实验室指标在肾综合征出血热(HFRS)患者病程中的动态变化规律,及其对病情重症化的预测价值。方法采用回顾性队列研究方法,纳入2019年1月至2022年1月空军军医大学第二附属医院(374例)和西安交通大学第二附属医院(20例)收治的394例HFRS患者,分为轻症组(轻型+中型)和重症组(重型+危重型)。收集患者基本信息、个人史、既往病史、治疗及并发症等临床资料,并记录住院第1、2、3、4、5、7、10、15、20、25天晨起及出院前末次实验室检查结果,分析患者常规实验室指标动态变化,评估各指标对病情重症化的动态预测价值。统计学比较采用曼-惠特尼U检验和χ2检验,采用受试者操作特征曲线评估各指标对重症化的预测价值。结果212例轻症组患者年龄为38(27,61)岁,182例重症组患者年龄为49(32,64)岁,差异有统计学意义(Z=-2.24,P=0.025)。重症组患者急性胰腺炎、急性呼吸窘迫综合征及多器官功能障碍综合征的发生率和血液净化及机械通气的使用率分别为6.0%(11/182)、12.6%(23/182)、19.8%(36/182)、89.6%(163/182)和22.5%(41/182),轻症组分别为0(0/212)、0(0/212)、0(0/212)、15.6%(33/212)和0.5%(1/212),差异均有统计学意义(χ^(2)=13.18、28.45、46.15、214.48、50.02,均P<0.05)。白细胞计数、淋巴细胞计数、单核细胞计数和中性粒细胞计数于第4至6病日达到峰值,分别为14.2(9.7,20.7)×10^(9)/L、4.2(2.3,6.2)×10^(9)/L、1.5(0.8,3.3)×109/L和8.3(4.3,11.4)×10^(9)/L。天冬氨酸转氨酶于发病3病日内达高峰[102(66,178)U/L]后迅速下降,于第12病日恢复至正常水平。血尿素氮和肌酐均于发病后平稳升高,第9至10病日达峰值,分别为13.2(7.7,19.1)mmol/L和255.4(122.9,400.9)μmol/L。凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原降解产物和D-二聚体水平于第3病日分别为12.7(12.0,13.2)s、38.7(33.5,51.9)s、12.6(6.9,32.0)mg/L和4.9(2.2,13.7)mg/L。第4病日血�Objective To investigate the dynamic changes of routine laboratory parameters during the course of hemorrhagic fever with renal syndrome(HFRS)and estimate the predictive value for the severity of the disease.Methods A retrospective cohort study was conducted,which enrolled 394 HFRS patients admitted to the Second Affiliated Hospital of Air Force Medical University(374 cases)and the Second Affiliated Hospital of Xi′an Jiaotong University(20 cases)from January 2019 to January 2022.The patients were divided into mild(mild and moderate)and severe(severe and critical)groups.The basic information,personal history,past history,treatment,complications and other clinical data of patients were collected and the results of the laboratory examinations in the morning at day 1,2,3,4,5,7,10,15,20 and 25 of hospitalization and before discharge were recorded.The dynamic changes of the patients′routine laboratory indicators and the dynamic predictive values of each indicator for severe condition were analyzed.Mann-Whitney U test and chi-square test were used for comparison,and receiver operator characteristic(ROC)curve was used for predictive value evaluation.Results The age of 212 patients in the mild group was 38(27,61)years,and that of 182 patients in the severe group was 49(32,64)years,the difference was statistically significant(Z=-2.24,P=0.025).The incidences of acute pancreatitis,acute respiratory distress syndrome,multiple organ dysfunction syndrome,the utilization rates of blood purification and mechanical ventilation in the severe group were 6.0%(11/182),12.6%(23/182),19.8%(36/182),89.6%(163/182)and 22.5%(41/182),respectively,and those in the mild group were 0(0/212),0(0/212),0(0/212),15.6%(33/212)and 0.5%(1/212)respectively,and the differences were all statistically significant(χ^(2)=13.18,28.45,46.15,214.48 and 50.02,respectively,all P<0.05).The levels of white blood cell count,lymphocyte count,monocyte count and neutrophil count were all increased rapidly after onset and peaked at days 4 to 6 of illness,with the

关 键 词：肾综合征出血热 实验室指标 动态变化 疾病严重程度 预测价值 

分 类 号：R512.8[医药卫生—内科学]