发热伴血小板减少综合征患者临床特征的预后价值分析  

Prognostic value of clinical features in patients with severe fever with thrombocytopenia syndrome

作　　者：李松 向旭 LI Song;XIANG Xu(Department of Laboratory Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院检验科,湖北武汉430030

出　　处：《检验医学与临床》2025年第6期835-838,844,共5页Laboratory Medicine and Clinic

摘　　要：目的 探讨发热伴血小板减少综合征(SFTS)患者临床特征对疾病预后的价值。方法 回顾性选取2023年4月1日至2024年8月31日华中科技大学同济医学院附属同济医院收治的269例SFTS患者作为研究对象,根据患者的临床结局,将其分为存活组(162例)和死亡组(107例)。比较2组患者入院时的一般资料、合并基础疾病情况和24 h内首次实验室指标[大别班达病毒(DBV)核酸载量、白细胞计数(WBC)、中性粒细胞绝对值(NEUT#)、淋巴细胞绝对值(LYMPH#)、血小板计数(PLT)、降钙素原(PCT)、高敏心肌肌钙蛋白Ⅰ(hs-TN Ⅰ)、γ-谷氨酰转移酶(GGT)、尿素氮(BUN)和血肌酐(Scr)]水平。采用多因素Logistic回归分析SFTS患者死亡的独立危险因素。结果 存活组DBV核酸载量、年龄、PCT及hs-TN Ⅰ、GGT、BUN、Scr水平低于死亡组,而PLT水平高于死亡组,差异均有统计学意义(P<0.05);而2组WBC、NEUT#、LYMPH#及发病至入院时间比较,差异均无统计学意义(P>0.05);多因素Logistic回归分析结果显示,年龄>66岁、DBV核酸载量>6.24 copy/mL、Scr>82.0μmol/L和神志改变均为SFTS患者死亡的独立危险因素(P<0.05)。结论 SFTS患者年龄偏大且体内DBV核酸载量高、Scr水平较高且出现神态改变时提示预后不良;联合评估患者的年龄、DBV核酸载量、Scr水平和神志状态有助于预防不良预后,为临床治疗提供依据。Objective To investigate the prognostic value of clinical features in patients with severe fever with thrombocytopenia syndrome(SFTS).Methods A total of 269 patients with SFTS admitted to Tongji Hospital from April 1 st 2023 to August 31 st 2024 were retrospectively selected as the study objects,which were divided into survival group(162 cases)and death group(107 cases)according to the clinical outcomes of the patients.The general information,comorbid underlying diseases and the first laboratory indexes[Dabie Bandavirus(DBV)nucleic acid load,white blood cell count(WBC),absolute neutrophil value(NEUT#),absolute lymphocyte value(LYMPH#),platelet count(PLT),procalcitonin(PCT),high-sensitivity cardiac troponin I(hs-TN I),gamma-glutamine transpeptidase(GGT),urea nitrogen(BUN)and serum creatinine(Scr)]levels within 24 h at the time of admission were compared between the two groups.Multivariate Logistic regression was used to analyze the independent risk factors for death in SFTS patients.Results The DBV nucleic acid load,age,and the levels of PCT,hs-TN I,GGT,BUN and Scr in the survival group were lower than those in the death group,while the PLT level was higher than that in the death group,and the differences were statistically significant(P<0.05).There were no significant differences in the WBC level,NEUT#,LYMPH#and the days from onset to admission between the two groups(P>0.05).Multivariate Logistic regression analysis results showed that age>66 years,DBV nucleic acid load>6.24 copy/mL,Scr>82.0μmol/L and mental disturbance were independent risk factors for death in patients with SFTS(P<0.05).Conclusion SFTS patients with older age,as well as high DBV nucleic acid load and Scr levels and mental disturbance,indicate poor prognosis;combined evaluation of patients′age,DBV nucleic acid load,Scr levels and mental condition can help prevent poor prognosis and provide a basis for clinical treatment.

关 键 词：大别班达病毒 发热伴血小板减少综合征 高敏心肌肌钙蛋白Ⅰ 年龄 核酸载量 预后 

分 类 号：R446.1[医药卫生—诊断学] R512.8[医药卫生—临床医学]