发热伴血小板减少综合征危重度评分对患者预后的评价

Role of severe fever with thrombocytopenia syndrome （SFTS）critical score in predicting the prognosis for SFTS patients

目的：探讨发热伴血小板减少综合征（SFTS）死亡相关因素，设立 SFTS 危重度评分并检验其对 SFTS 患者预后的评价作用。方法对2011年6月至2014年10月山东大学附属济南市传染病医院住院治疗并确诊为 SFTS 的123例患者行死亡相关危险因素的 Logistic 回归分析，进而设定 SFTS危重度评分，并通过受试者工作特征曲线（ROC）与快速急诊内科评分（REMS 评分）、急性生理和慢性健康评分系统Ⅱ（APACHEⅡ）进行预后预测能力的比较。结果123例患者中死亡31例（死亡组），男17例，女14例；生存92例（生存组），男45例，女47例。单因素 Logistic 回归分析结果显示，格拉斯哥昏迷（GCS）评分、乳酸脱氢酶、部分活化凝血活酶时间、脉搏血氧饱和度与 SFTS 死亡相关，差异均有统计学意义（均 P ＜0．05）。且4项指标的单项评分，死亡组均高于存活组（均 P ＜0．05）。SFTS 死亡组的REMS、APACHEⅡ评分和 SFTS 危重度评分均高于存活组（均 P ＜0．01）。REMS、APACHEⅡ评分和SFTS 危重度评分的曲线下面积（AUC）分别为0．734、0．746、0．788。Youden 指数以 SFTS 危重度评分为最高，当取阈值为15．0时，其预测 SFTS 患者住院期间死亡风险的敏感度为74．2％，特异度为76．1％。结论 REMS、APACHEⅡ评分和 SFTS 危重度评分对 SFTS 预后均具有良好的评价作用，其中以 SFTS 危重度评分更为简捷且预测能力最佳。

Objective To investigate of the risk factors for the death of severe fever with thrombocytopenia syndrome （SFTS）,so as to set up SFTS critical score and evaluate its role in predicting the prognosis for patients with SFTS.Methods A total of 123 SFTS patients hospitalized in Ji′nan Hospital of Infectious Diseases affiliated to Shandong University from June 2011 to October 2014 were enrolled in this study.The univariate Logistic regression analysis was performed to analysis the risk factor for the death of SFTS.Then the SFTS critical score system was set up accordingly.The prognosis value of SFTS critical score was compared with the rapid emergency medicine score （REMS）and the acute physiology and chronic health evaluation Ⅱ （APACHEⅡ）by using receiver operator characteristic curve （ROC）.Results Among all the patients,17 males and 14 females were in death group,and 45 males and 47 females were in survival group.The results of the univariate Logistic regression analyses indicated that the glasgow coma scale （GCS）,lactate dehydrogenase,activated partial thromboplastin time,oxygen saturation were risk factors for the death of SFTS,with statistically significant difference （all P 〈0.05）. All of the four parameters of SFTS critical scores in the death group were higher than those in the survival group,with statistically significant difference （all P 〈0.05 ）.The REMS,APACHEⅡ score and SFTS critical score in the death group were significantly higher than those in the survival group （all P 〈0.01 ）.＆amp;nbsp;The area under the curve （AUC）of REMS,APACHE Ⅱ scores and SFTS critical score were 0.734, 0.746 and 0.788,respectively.The Youden index of the SFTS critical scores was the highest among all three scores （P 〈0.01）.If 15 .0 was used as the cut off value of SFTS critical score,the specificity and the sensitivity for predicting the death risk for the hospitalized patient were 74.2% and 76.1 %, respectively.Conclusion SFTS critical score,REMS and APACHEⅡ score can all effectively predict the prognosis for SFTS patients,among which,the SFTS critical score is the most convenient and has the best predictive value.