发热伴血小板减少综合征患者临床特征分析

Study on the clinical characteristics of severe fever with thrombocytopenia syndrome bunyavirus patients

【目的】探讨发热伴血小板减少综合征(severe fever with thromobocytopenia syndrome,SFTS)患者临床特征。【方法】采用回顾性调查、现场流行病学调查方法进行问卷调查,使用实时定量反转录聚合酶链反应(rRT-PCR)方法检测SFTS患者血液、排泄物中的SFTSV RNA。【结果】共43例患者,均为农民,其中男20例,女23例。大多数病例没有蜱叮咬史,但发病前2周均有树木、草丛等野外活动史或田间劳动史。主要临床症状多为发热、全身不适、肌肉酸痛、乏力、纳差、头痛、恶心、呕吐、咳嗽、咳痰、咽痛、腹痛、腹泻等;实验室检查主要是WBC、PLT降低,ALT、AST、CK、LDH升高,蛋白尿、血尿。39例患者血液标本SFTSV RNA检测阳性(90.70%)。所有病例的尿液、粪便、咽拭子标本未检测到SFTSV RNA。【结论】SFTS患者临床表现以发热伴白细胞、血小板减少和多脏器功能损害为主;患者血液中有SFTSV RNA存在;排泄物中虽未检测出SFTSV RNA,但仍需进一步深入研究。

[Objective]To investigate the clinical characteristics and the RNA of severe fever with thmmobocytopenia syndrome bunyavirus （SFTSV） in blood and excretion of patients with severe fever with thromobocytopenia syndrome（SFTS） for the prevention and treatment of the disease. [Methods] Epidemiologic, clinical data were collected by interviewing patients and retrieving medical records. Real time fluoresent quantitative reverse transcripion-polymerase chain reaction assays （rRT-PCR） was performed to detect the RNA of SFISV. [Results] A total of 43 patients, including 20 males and 23 females, all were farmers. Most patients have no history of tick bite, but have history of outdoor activities in trees, bushes or field labor. The major clinical symptoms were infection and toxic symptoms included fever, malaise, muscle aches, fatigue, anorexia, headache, nausea, vomiting, cough, sputum, sore throat, abdominal pain, diarrhea, etc. The most common abnormalities of laboratory findings were thrombocytopenia and leukocytopenia, elevation of serum alanine（ALT）, aspartate aminotransfer（AST）, creatine kinase（CK） levels, proteinuria and hematuria. There were 90.70% （39/43） case with SFTSV RNA detection positive. No SFTSV RNA was detected in throat swabs, urine, and fecal specimens in all the cases. [Conclusion] Most patients have a moderately severe febrile illness with thrembocytopenia, leukopnia and organ failure. The existence of SFTSV RNA in the blood should be Carefully treated while the nonexistence of SFTSV RNA in the excretion of patients with SFTS should be further studied