肾综合征出血热患者发热期血象变化与病情及预后的关系

Relationship between blood changes and prognosis in patients with hemorrhagic fever with renal syndrome

目的提高临床肾综合征出血热(HFRS)早期诊疗水平,降低死亡率。方法回顾性分析2011年1月至2015年10月东莞市人民医院收治的住院确诊的94例HFRS患者的临床资料,对HFRS病情及预后,以及其与发热期血液系统指标的关系进行分析。结果 94例肾综合征出血热病例轻型病例22例,中型病例66例,重型病例2例,危重病例4例(因重型及危重型病例较少,统一合并为一组);在病情方面,轻型、中型及重型三组间白细胞数值依次升高,差异有统计学意义(P=0.02),提示白细胞数值与病情相关;在预后方面,存活组及死亡组两组间血小板数值比较,死亡组血小板明显降低,差异有统计学意义(P=0.03),提示血小板数量与预后相关。结论临床上应重视早期血象改变,为病情分级及预后提供依据,做到早诊断、早治疗,提高抢救成功率。

Objective To improve the diagnosis and treatment of hemorrhagic fever with renal syndrome（HFRS）,and lowerthe death rate. Methods Clinical data of 94 patients with HFRS who were diagnosed and treated in the inpatient departmentof Dongguan People′s Hospital from Jan 2011 to Oct 2015 were collected and analyzed retrospectively. Disease activity andprognosis of HFRS were summarized and the association between disease activity,prognosis and blood parameters valuesduring fever were analyzed. Results Of the 94 patients with HFRS,the majority was with mild and moderate diseaseactivity. Only a minority was at high disease activity.In the condition of light,medium and heavy white blood cells between thethree groups were compared（P=0.02）;the difference was statistically significant,suggesting that the number of white bloodcells and disease was related. In the prognosis of the two groups,the P value was 0.03;the difference was statisticallysignificant,suggesting that the number of platelets was related to the prognosis. Conclusion We should pay close attention tothe abnormal hemogram parameters at early disease stage in clinical practice,because they could be index for disease activityand prognosis,providing guidance to start treatment as early as possible,and to increase the successful rescue rate of HFRS.