新型布尼亚病毒感染68例临床特征及预后分析

Clinical characteristics and prognosis of novel bunyavirus infection： 68-case report

目的 回顾性分析新型布尼亚病毒感染患者的临床特征及其预后.方法 收集威海市文登中心医院经实验室确诊的68例新型布尼亚病毒感染的住院患者的临床资料,分析其流行病学、临床表现、实验室检测结果及预后的特征.结果 68例患者中有貂类养殖史或被貂咬伤史22例（32.4％）,发病2周内蜱虫叮咬史4例（5.9％）,因陪护新型布尼亚病毒感染的重症患者发病5例（7.4％）,25例（36.8％）患者均有野外作业史;年龄＞60岁34例（50.0％）,有基础疾病27例（39.7％）.所有患者首发症状均为发热,伴有食欲不振、乏力等全身中毒症状,并出现多系统功能损害;伴神经系统损害27例（39.7％）,消化道出血4例（5.9％）及快速心房颤动10例（14.7％）,合并肺炎18例（26.5％）.血白细胞计数≤2.0×10^9/L 55例（80.9％）,血小板计数≤30×10^9/L 18例（26.5％）;肝功能损害62例（91.2％）,心肌酶升高68例（100.0％）;活化部分凝血活酶时间延长44例（64.7％）;低血钠23例（33.8％）、低血钾29例（42.6％）、低血钙36例（82.4％）,高血糖49例（72.1％）;新型布尼亚病毒核酸定量在1.10×10^2～5.78×10^7组织培养感染剂量（TCID）/mL.治愈55例,占80.9％,死亡13例,占19.1％.结论 与貂及患者密切接触、蜱虫叮咬、野外作业人群是新型布尼亚病的易感人群,高龄、有基础疾病、伴严重神经系统损害、出血、肺炎、血小板计数显著降低、心肌酶显著升高、高病毒载量者预后较差.

Objective To retrospectively analyze the clinical characteristics,prognosis and risk factors of novel bunyavirus infection.Methods The clinical data of 68 patients with novel bunyavirus infection confirmed by laboratory diagnosis at Wendeng Central Hospital of Weihai were retrospectively collected.Epidemiological characteristics,clinical manifestations,physical signs and laboratory results were analyzed.Results Twenty two patients （32.4 %） had intimate contact with ermine （breeding ermine or ermine biting） ; 4 patients （5.9%） had been bitten by tick within 2 weeks,6 patients （7.4%） had intimate contact with patients with severe fever with thrombocytopenia syndrome （SFTS） ; and 25 patients （36.8 %） had a history of fieldwork before the onset of the disease.Thirty-four patients （50.0 %） were over 60 years old and 27 cases （39.7%） had underlying diseases.Initial symptoms in all patients were fever accompanied by loss of appetite,fatigue and other toxemic symptoms,followed by multi organ damage.Other clinical manifestations included nervous system damage （27 cases,39.7%）,hemorrhage （4 cases,5.9%）,rapid atrial fibrillation （10 cases,14.7%） and pneumonia （18 cases,26.5%）.White blood cell count of 55 cases （80.9%） was less than or equal to 2.0 × 109/L,platelet count of 18 cases （26.5%） was less than or equal to 30 × 10^9/L.Abnormal hepatic function was found in 62 cases （91.2%）; elevated myocardial enzymes was found in 68 cases （100.0%）,prolonged activated partial thromboplastin time in 44 cases （64.7%）,hyponatremia in 23 cases （33.8%）,hypokalemia in 29 cases （42.6%）,hypocalcemia in 36 cases （82.4%）,hyperglycemia in 49 cases （72.1%）.Serum nucleic acid quantitation of novel bunyavirus varied from 1.10 × 10^2 to 5.78 × 10^7 tissue culture infective dose （TCID）/ mL.Fifty five cases were cured,accounting for 80.9 %,while 13 （19.1%） died eventually.Conclusions High risk factors of novel bunyavirus infection included intimate contact with ermine and infected patients,tick biting and fieldwork.Patients with elder age,underlying diseases,nervous system symptoms,hemorrhage,pneumonia,low platelet,high viral load and elevated myocardial enzymes may have poor progonsis.