104例肾综合征出血热远期随访研究

A Long-Term Follow-up Study of Hemorrhagic Fever with Renal Syndrome

目的:探讨肾综合征出血热(HFRS)患者临床缓解后有无远期肾损害及其他后遗症。方法:随访HFRS恢复患者104例(HFRS组),询问病史,进行常规体检,检查血常规、尿常规、肝肾功能、血脂、胸透或胸片、心电图、肝胆脾及双肾B超、汉坦病毒(HV)IgG抗体。同时选择同一地区,性别、年龄类似,无HFRS病史的84例作为对照组,其中HV-肾综合征出血热病毒IgG抗体阳性的患者作为HV隐性感染组,HV-IgG抗体肾综合征出血热病毒IgG抗体阴性的患者者作为HV非感染组,均进行相同检查,对3组的检查结果进行对比研究分析。另外随机选择无肾综合征出血热病史的慢性肾脏疾病患者血清43份,初步探讨慢性肾脏疾病与汉坦病毒感染之间的关系。结果:104例HFRS恢复患者中97例(93.27%)HV-IgG抗体阳性,对照组23例(27.38%)HV-IgG抗体阳性。HFRS组104例中8例(7.69%)尿蛋白阳性(≥+),高于HV非感染组(0%),两组进行比较,有显著性统计学差异(P=0.027)。HFRS组有垂体功能减退1例;慢性肾炎、肾移植患者1例。结论:大部分HFRS恢复患者HV-IgG抗体可长期存在。HFRS急性感染后,远期肾损害发生率明显高于正常人群,是否与HV的持续性感染有关,值得进一步的研究。

Objective：To investigate whether there are long-term renal injury and other complications in patients recovered from hemorrhagic fever with renal syndrome （HFRS） after acute Hantan virus （HV） infection. Methods： All 104 subjects （HFRS group） recovered from HFRS finished a clinical questionnaire, underwent physical examination, B ultrasound scanning, ECG, and chest X-ray examinations, and the blood and urine samples were collected for general clinical chemistry tests and determination for HV-IgG antibody. Another 84 age- and residence-peered subjects, without history of HFRS, were recruited as control group, and this group was sub-divided into HV covert infection group and HV non-infection group according to whether or not they had HV-IgG antibody. The results of the three groups were analyzed statistically. Results： The rate of seropositivity for HV-IgG antibody in the patients and in control group was 93.27% （97/104） and 27.38% （23/84） respectively. The rate of hyperproteinuria in the patients was significantly higher than that in HV non-infection group （7.69% vs 0%, P=0.027）. In HFRS group, one patient had hypohypophysism several years after HV infection, and one suffered with chronic renal disease, and developed into chronic renal failure and received renal transplantation at last. Conclusion： Most patients recovered from HFRS remain HV-IgG positive for a long time,and the incidence of long-term renal injury in the patients may be higher, as compared with that in healthy persons.It is worth further researching into whether the long-term renal injury may be related to potentially persistent HV infection.