云南楚雄州2014-2015年肾综征出血热报告及临床特征分析

Analysis for hemorrhagic fever with renal syndrome reported and clinical features in Chuxiong Prefecture from 2014 to 2015

目的了解2014-2015年楚雄州肾综征出血热(HFRS)病例的报告情况及临床特征,为该病的诊断及报告提供科学依据。方法通过肾综征出血热个案调查,收集病例的临床症状、体征和实验室检查资料进行描述性分析。结果楚雄市HFRS传染病疫情网络报告病例占总数的93.6%;140例HFRS病例主要临床表现为起病急(93.6%),发热(91.4%),乏力(84.3%),全身痛症状(57.9%),腹痛为(41.4%),恶心(60.7%);实验室检查主要特点为白细胞计数增多(40.0%),血小板减少104例(74.3%);尿蛋白阳性(58.6%);特异性Ig M抗体阳性率83.8%(98/117)。结论楚雄州10县市HFRS报告率差异较大,病例临床表现不典型,易造成误诊;基层医疗机构对肾综征出血热的发现与诊断能力有限,应加强基层临床医生对HFRS诊断报告专业技术的培训与指导,提高诊断及报告的能力与意识。

Objective To investigate the reports and clinical features of hemorrhagic fever with renal syndrome（HFRS） in Chuxiong Prefecture from 2014 to 2015 and provide a scientific guidance for the diagnosis and reporting. Methods Descriptive epidemiological analysis was conducted on the individual questionnaire of HFRS for the clinical symptom, signs and laboratory examination results of the Patients. Results The nationwide network direct reports of Chuxiong county accounting for 93.6% of the total. The clinical manifestation of 140 cases with HFRS were rapid progress（93.6%）, fever（91.4%）, hypodynamia（84.3%）, pantalgia（57.9%）, abdominalgia（41.4%）, nausea（60.7%）. The major abnormal of laboratory examination were abnormal leukocytosis（40.0%）, thrombocytopenia（74.3%）, urinary protein（58.6%）. The positive rate of specific Ig M antibody was 83.8%（98/117）. Conclusion The nationwide network direct reporting rate of HFRS had significantly differences of 10 counties in Chuxiong Prefecture. Clinical manifestation of the HFRS was not typical, it is very easy to be misdiagnosed. The basic medical institutionsˊs capacities of disease clinical diagnosis and laboratory confirmation for HFRS are limited. It is necessary to increase the investment for basic medical doctors and conuct training on HFRS diagnosis and reporting.