蓬莱市2010—2014年发热伴血小板减少综合征死亡病例分析

Epidemiological analysis of severe fever cases accompanied with thrombocytopenia syndrome in Penglai city from 2010 to 2014

目的研究发热伴血小板减少综合征(简写SFTS)死亡病例的早期临床表现和流行特征,探讨死亡可能影响因素。方法对2010—2014年蓬莱市发热伴血小板减少综合征死亡病例采用描述性流行病学方法分析。结果 SFTS死亡病例多为老年农民,平均死亡年龄为65.76岁,死亡高峰为6—9月,发病前均有到野外干农活或接触牛羊。大部分患者发病早期以高烧、全身不适、乏力、肌肉酸痛为主,主要体征为浅表淋巴结肿大(57.89%)、舌体或肢体震颤(42.11%)和肾区或肝区叩痛(31.58%),白细胞(94.74%)、血小板(94.44%)计数减少,ALT(76.47%)、AST(100%)、CK(58.33%)、血糖(88.24%)升高,部分伴有血尿、粪潜血阳性。发病至初次就诊二级以上医院时间间隔平均4.95d,52.63%病例转诊一次,从县级以下医院转诊至县级以上医院平均5.11d,首诊在村卫生室或私人诊所输液(57.89%)、伴有慢性基础性疾病(52.63%)较多。结论发热伴血小板减少综合征死亡病例发病初期临床表现无特异性,初诊多伴有肝肾和神经系统损害,就诊不及时,滞留在村级卫生医疗机构较长,伴有慢性基础性疾病可能是导致死亡病例发生的重要因素。

Objective To understand the early clinical characteristics of cases died of severe fever accompanied withthrombocytopenia syndrome（SFTS）and explore the main risk factor. Methods Descriptive epidemiological method wasapplied to analyze the data of 21 cases died of severe fever with thrombocytopenia syndrome in Penglai city during 2010-2014.Results Most deaths were elderly farmers averagely with age of 65-76 years and 66.67% of the case were reported from Juneto September. All patients had the history of working in the fields or exposed to livestocks. The main early clinical symptomswere severe fever, fatigue and muscle soreness and 90.5% of the dead cases showed lymph node enlargement, 42.11% of themshowed limb and tongue tremor and 31.58% of them showed sensitive to percussion in hepatic and kidney region.Lleukocytopenia and thrombocytopenia were observed in 94.74% and 94.44% of the deaths and elevated serum levels of ALT,AST, CK and GLU were notived in 76.47%, 100%,58.33% and 88.24% of the deaths. Hematuria and fecal occult bloodoccurred to partial dead cases. The average admission time was 4.95 days and 52.63% of cases were transferred from townshiphospitals village clinics to county-level hospital with an average duration 0f 5.11 days, 57.89% of them were first diagnosedand treated in village clinics or private clinics and 52.63% of them had underlying diseases. Conclusion No specificfeatures were observed in dead SFTS cases at early clinical stage. It suggested that patients with underlying diseases,liver,kidney and nervous system dysfunction on admission have higher death risk. Delayed treatment is also one of the risk factors.