发热伴血小板减少综合征患者临床特征及危险因素分析  

Clinical features of severe fever with thrombocytopenia syndrome and risk factors

作　　者：刘洋 孟秋云[2] 朱琦光 封杨[1] LIU Yang;MENG Qiu-yun;ZHU Qi-guang;FENG Yang(Department of Infectious Diseases,Tai'an Central Hospital,Tai'an,Shandong 271000,China;Tai'an Fouth People's Hospital,Tai'an,Shandong 271000,China)

机构地区：[1]泰安市中心医院感染性疾病科,山东泰安271000 [2]泰安市第四人民医院,山东泰安271000

出　　处：《中国媒介生物学及控制杂志》2024年第4期478-482,共5页Chinese Journal of Vector Biology and Control

摘　　要：目的分析发热伴血小板减少综合征(SFTS)不同严重程度患者的临床特征,及影响其严重程度的危险因素,为临床诊疗及预防该病提供参考依据。方法收集2013年3月—2019年11月山东省泰安市市区所有医院感染性疾病科及重症医学科住院诊治的75例SFTS实验室确诊病例入院时的临床病例资料。根据相关标准将患者分为普通组和危重组,比较2组患者临床特征及相关指标差异,计量资料使用独立t检验和Mann-Whitney U检验分析。计数资料采用χ^(2)检验或Fisher确切概率检验分析。使用二元logistic回归和受试者工作特征曲线(ROC)法进行影响因素分析。结果危重组与普通组比较,患者的年龄、住院时间,出现畏寒、出血症状、呼吸困难、神经系统症状,谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CKMB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、肌酐、总蛋白、白蛋白、血钾、血钠、血氯、血钙等20个异常指标差异有统计学意义(均P<0.05);多因素logistic回归分析显示,APTT、TT 2个异常指标与SFTS严重程度有显著性关系(χ^(2)=7.839,P=0.005;χ^(2)=4.814,P=0.028),OR值分别为1.082(1.024~1.143)和1.171(1.017~1.348);ROC诊断曲线分析显示,APTT、TT的曲线下面积(AUC)值分别为0.826和0.771(均P<0.001)。结论APTT、TT延长是影响疾病严重程度的主要危险因素,针对存在以上危险因素的患者,应早期识别、干预及治疗,从而降低患者死亡率。Objective To investigate the clinical features of patients with severe fever with thrombocytopenia syndrome(SFTS)of different severity levels and risk factors affecting the severity of SFTS,so as to provide a reference for the clinical diagnosis and treatment and prevention of the disease.Methods The clinical data of 75 patients with laboratory-confirmed SFTS hospitalized in the department of infectious diseases and department of intensive care medicine of every hospital were collected in Tai'an,Shandong Province,China from March 2013 to November 2019.According to the specific criteria,these patients were divided into non-critical group and critical group.Clinical features and clinical indicators were compared between the two groups.Continuous data were compared using the independent t test and Mann-Whitney U test.Categorical data were compared using the Chi-square test or Fisher's exact test.Risk factors were determined by using binary logistic regression analysis and receiver operating characteristic(ROC)curves method.Results The critical group differed significantly from the non-critical group in terms of 20 indexes,including age,the length of hospital stay,chills,bleeding symptoms,dyspnea,nervous system symptoms,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,creatine kinase-MB,prothrombin time,activated partial thromboplastin time(APTT),thrombin time(TT),creatinine,total protein,albumin,potassium,sodium,chlorine,and calcium(all P<0.05).Multivariable logistic regression analysis detected statistical significance in APTT[odds ratio(OR)=1.082(1.024~1.143),χ^(2)=7.839,P=0.005]and TT[OR=1.171(1.017~1.348),χ^(2)=4.814,P=0.028].The areas under the ROC curves for APTT and TT were 0.826 and 0.771,respectively(both P<0.001).Conclusions Prolonged APTT and TT are main risk factors affecting the severity of SFTS.For patients at risk,early identification,intervention,and treatment can help reduce their mortality.

关 键 词：发热伴血小板减少综合征 危重病例 临床特征 危险因素 

分 类 号：R384.9[医药卫生—医学寄生虫学]