发热伴血小板减少综合征169例临床研究

The clinical characteristics of 169 cases of severe fever with thrombocytopenia syndrome

目的通过分析169例发热伴血小板减少综合征（SFTS）的临床特点，提高对该病的认识。方法对解放军第一五四医院2010年10月至2011年5月收治的169例SFTS患者的临床表现、实验室检查结果及预后进行回顾性分析总结，按照预后将患者分为轻症和危重症两组，比较两组患者的差异，探讨危重症患者的预测指标。结果本组患者均生活居住在丘陵地带，多有野外作业史，主要临床表现为发热（98．8％，167／169）、头痛（52．1％，88／169）、肌肉酸痛（95．9％，162／169）、恶心（73．4％，124／169）、呕吐（67．5％，114／169）、咳嗽（61．5％，104／169）等；45．0％（76／169）患者可触及浅表淋巴结肿大伴触痛，36．7％（62／169）患者可见皮肤淤点、淤斑。危重症患者主要见于60岁以上的老年人，神经系统、循环系统症状及呼吸困难、咯血表现突出，严重血小板减少发生率可达73．3％（22／30），AST、乳酸脱氢酶和肌酐、尿素氮的水平显著高于轻症患者[235（47～1750）U／L比88（14～2000）U／L；997（281～2601）U／L比399（26～2633）U／L；101（62～291）μmol／L比70（26～205）μmol／L；7．0（2．2～20．0）mmol／L比4．8（1．4～18．5）mmol／L，P值均〈0．001]。结论神经系统症状及AST、肌酐、尿素氮升高是危重症SFTS患者预后的危险因素，对此类患者应特别予以重视。

Objective To analyze the clinical characteristics of severe fever with thromboeytopenia syndrome （SFTS） so as to improve the recognition of the emerging infectious disease. Methods A retrospective analysis was performed upon clinical manifestations, laboratory test results and prognostic features of 169 patients with SFTS admitted to the 154 Hospital, Chinese People＇s Liberation Army from October 2010 to May 2011. The patients were divided into moderate disease group and severe disease group according to the prognosis. The differences between two groups were compared to explore the prognostic indicator of severe type. Results All patients with SFTS inhabited in hilly ground with history of field work. The main clinical symptoms were severe fever （98.8% , 167/169）, headache （52. 1% ,88/169）, muscle soreness （ 95.9% , 162/169 ）, nausea （ 73.4%, 124/169 ）, vomiting （ 67.5%, 114/169 ）, coughing （61.5%, 104/169）, etc. Superficial lymph node enlargement with haphalgesia was observed in 45.0% （76/169） patients. Petechia or ecchymosis was observed in 36. 7% （62/169） patients. Critical patients were mainly aged 〉 60 years, associated with nerve and circulatory system syndrome, prominent hemoptysis, dyspnea, and nearly 73.3% （22/30） of severe thrombocytopenia. Serum levels of aspartate aminotransferase, creatinine and urea nitrogen were significantly higher in severe disease group than those in moderate disease group [ 235 （47-1750） U/L vs 88 （14-2000） U/L, 997 （281-2601 ） U/L vs 399 （ 26-2633 ） U/L, 101 （ 62-291 ） μmol/L vs 70 （ 26-205 ） μmol/L, 7.0 （ 2. 2-20. 0） mmol/L vs 4. 8 （ 1.4-18.5 ） mmol/L, all P values 〈 0. 001 ]. Conclusion Nerves system syndrome, transaminase and urea nitrogen are risk factors of prognosis of severe SFTS to whom deserves paying attention.