重症发热伴血小板减少综合征预警指标分析

doi:10.19871/j.cnki.xfcrbzz.2023.05.008

摘要/Abstract

摘要： 目的对90例发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者的实验室数据和临床特征进行分析,寻找重症患者预警指标,为临床干预提供依据。方法收集2020年3月至2021年9月安庆市立医院感染科收治的90例SFTS患者,按病情轻重分为轻症组和重症组,其中轻症组44例,重症组46例,比较两组的流行病学特征、临床特征、实验室指标。结果 90例患者均为散发病例,88例为农民,女性62例,男性28例,发病高峰主要集中在4–9月份。与轻症组比较,重症组中位年龄更高（分别为62岁和66岁,Z=-2.032,P=0.042）;重症组热程更长(Z=-2.558,P=0.010)、皮肤瘀点瘀斑发生率更高(χ²=9.406,P=0.002);重症组降钙素原、C反应蛋白、肌酐、尿素氮、谷草转氨酶、乳酸脱氢酶、肌酸激酶均高于轻症组（Z值分别为-2.041、-2.054、-3.576、-4.571、-4.452、-4.993、-4.500,均P<0.05）,而血钙（t=-3.471）、血小板（Z=-8.124）、淋巴细胞计数（Z=-1.959）低于轻症组,差异均有统计学意义（均P<0.05）;重症组并发中枢神经系统异常、肺炎、心肌损害、心动过缓、肝功能不全、横纹肌溶解的发生率均高于轻症组（χ²分别为4.155、8.897、12.018、9.961、16.365、6.123,均P<0.05）。Logistic回归分析提示中枢神经系统异常（OR=20.314,95%CI：0.886~45.695）、血小板(OR=0.93,95%CI：0.888~0.973)、心肌损害（OR=4.813,95%CI：1.149~20.162）为重症预警独立危险因素。结论 SFTS临床症状多样,出现血小板明显下降、中枢神经系统异常或是心肌酶谱异常,应警惕可能进展为重症SFTS。

关键词: 发热伴血小板减少综合征, 新型布尼亚病毒, 临床特征, 重症

Abstract: Objective The laboratory data and clinical features of 90 patients with fever with thrombocytopenia syndrome (SFTS) were analyzed to find out the warning indicators of severe patients and provide basis for timely intervention. Method From March 2020 to September 2021, 90 patients with SFTS were collected from the Infection Department of Anqing Municipal Hospital. They were divided into mild group and severe group according to the severity of the disease, including 44 cases of mild group and 46 cases of severe group. The epidemiological characteristics, clinical characteristics and laboratory indicators of the two groups were compared. Result All 90 cases were sporadic cases, with 88 being farmers, 62 females, and 28 males. The peak of incidence was mainly from April to September. Compared with the mild group, the median age of the severe group was higher (66 years and 62 years, respectively, Z=-2.032, P=0.042); The severe group had a longer heat course (Z=-2.558, P=0.010) and skin ecchymosis and ecchymosis has a higher incidence rate（χ²=9.406, P=0.002); The indexes of calcitonin, creactive protein, creatinine, blood urea nitrogen, aspartate aminotransferase, lactate dehydrogenase, and C reatine kinase in the severe group were higher than those in the mild group (Z values were -2.041, -2.054, -3.576, -4.571, -4.452, -4.993, and -4.500, respectively, P<0.05), while blood calcium (t=-3.471), platelet (Z=-8.124), and lymphocyte count (Z=-1.959) were lower than those in the mild group, with statistical significance (all P<0.05); The incidence rates of central nervous system abnormalities, pneumonia, myocardial damage, bradycardia, liver insufficiency and rhabdomyolysis in the severe group were higher than those in the mild group (χ²=4.155, 8.897, 12.018, 9.961, 16.365, 6.123, all P<0.05). Logistic regression analysis showed that central nervous system abnormalities (OR=20.314, 95%CI:0.886-45.695), PLT(OR=0.93, 95%CI:0.888-0.973), and myocardial damage (OR=4.813, 95%CI:1.149-20.162) are independent risk factors for severe warning. Conclusion The clinical symptoms of SFTS are diverse. If there is a significant decrease in platelets, abnormalities in the central nervous system, or abnormalities in the myocardial enzyme spectrum, patients should be vigilant that they may progress to severe SFTS.

Key words: Severe fever with thrombocytopenia syndrome, Severe fever with thrombocytopenia syndrome virus, Clinical features, Severe illness

中图分类号:

R512.8

霍雪平, 刘贞君, 谢琴秀. 重症发热伴血小板减少综合征预警指标分析[J]. 新发传染病电子杂志, 2023, 8(5): 41-45.

Huo Xueping, Liu Zhenjun, Xie Qinxiu. Analysis of early warning indicators of severe fever with thrombocytopenia syndrome[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(5): 41-45.

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