发热伴血小板减少综合征重症及死亡危险因素的Logistic回归分析

Logistic regression analysis on risk factors of fatal and severe associated with thrombocytopenia syndrome

目的分析发热伴血小板减少综合征（SFTS）患者的临床特征和危险因素。方法收集2011年5月至2012年7月解放军第一五四医院就诊的273例SFI＇S患者的相关信息，采用RT-PCR检测新布尼亚病毒（sgrsv），通过ELISA检测SFrSV-IgM和IgG抗体，采用Human BioPlex ProT MAssays 17-Plex Panel方法测定细胞因子。对确诊病例采用单因素、多因素Logistic回归模型分析SFTS病例重症和死亡发生的危险因素。结果273例sFrs患者中180例SFTSV核酸阳性。主要临床表现为发热、乏力、肌肉酸痛和胃肠道症状。多因素Logistic分析显示，年龄≥60岁（OR=I．08，95％C1：1．03-1．13）、淋巴结肿大（OR=3．75，95％CI：1．45—9．66）、下呼吸道感染（OR=3．57，95％CI：1．40-9．11）、肌酐（Cr）〉97mmol／L（OR=4．10，95％CI：1．55-10．82）及意识障碍（OR：3．35，95％CI：1．21—9．29）与重症病例发生显著相关。年龄≥60岁（OR=1．06，95％CI：1．00—1．12），下呼吸道感染（OR=4．33，95％CI：1．35—13．93），Cr〉97mmol/L（OR=10．14，95％CI：3．19-32．21）及意识障碍（OR=3．47，95％CI：1．03-11．72）与死亡病例发生显著相关。结论年龄I〉60岁、合并下呼吸道感染、Cr〉97mmo]／L、意识障碍是Sn’s患者预后不良的危险因素，应予重点治疗。

Objective To analyze the clinical characteristics and risk factors of severe fever with thrombocytopenia syndrome （SFTS）. Methods The data of 273 SFTS patients admitted to the 154th Hospital of People＇s Liberation Army from May 2011 to July 2012 were analyzed. Severe fever with thrombocytopenia syndrome bunyavirus （SFTSV） was detected by RT-PCR, SFTSV-IgM, and SFTSV-IgG were detected by ELISA, and cytokines was detected by Human BioPlex ProTM Assays 17-Plex Panel method. The risk factors for SFTS severe cases and deaths occurred were analyzed by singal factor and multi-factor logistic regression method. Results A total of 180 laboratory-confirmed SFTSV positive cases among 273 SFTS patients were included in the study, with clinical presentations of fever, weakness, myalgia and gastrointestinal symptoms. The muhi-factor logistic analysis showed that there were significant correlations between severe cases and age 1〉60 （OR=1.08, 95%C1： 1.03-1.13）, lymphadenectasis （0R=3.75,95%CI： 1.45-9.66）, lower respiratory tract infection （0R=3.57, 95%C1： 1.40-9.11）, creatinine（Cr）〉97 mmol/L （ OR =4.10, 95%CI： 1.55-10.82） and consciousness disorder （OR= 3.35, 95%CI： 1.21-9.29）. There were significant correlations between death cases and age I〉60 （OR=1.06,95% CI： 1.00-1.12）, lower respiratory tract infection （OR=4.33,95%CI： 1.35-13.93）, Cr〉97 mmol/L（OR=10.14,95% CI：3.19-32.21） and consciousness disorder （OR=3.47,95%CI：1.03-11.72）. Conclusions Older age （≥60）, pulmonary infection, Cr〉97 mmol/L, impairment on renal function and nervous system are the most notable risk factors.