发热伴血小板减少综合征患者的临床特点与生存状况

Clinical characteristics and survival of patients with fever with thrombocytopenia syndrome

目的研究发热伴血小板减少综合征(SFTS)患者的临床特征及生存状况。方法回顾性分析自2015年1月至2016年1月该院111例SFTS患者的临床资料,分别对患者的流行病学特征、临床特点及体征、实验室检查、治疗经过及转归资料进行分析,采用酶联免疫吸附试验(ELISA)对患者血清中新型布尼亚病毒(SFTSV)-IgG抗体进行检测。结果 111例SFTS患者中有92例患者经治疗后完全康复,生存率为82.88%;19例患者治疗无效死亡,病死率为17.12%。SFTS发病高峰期为6~8月,57.66%的患者主要为生活在丘陵地区从事农业生产的农民,年龄为49~80;患者临床特点包括高热、头痛、畏寒等发热症状,纳差、恶心、呕吐、腹泻等胃肠道不适,乏力、全身不适等感染中毒症状;患者的体征主要为腋窝及腹股沟等部位淋巴结肿大、触痛,肢体震颤等;实验室检查发现患者天门冬氨酸氨基转移酶(AST)、丙氨基酸氨基转移酶(ALT)、肌酸肌酶(CK)、乳酸脱氢酶(LDH)4项指标升高,白细胞计数(WBC)、血小板计数(PLT)2项指标降低,且伴有血尿、蛋白尿。结论 SFTS临床表现多种多样、极为复杂,常伴有多器官损伤、衰竭,神经系统损伤,肺部重症感染,感染性休克等并发症。其预后差、病死率较高,需要对患者进行对症治疗,加强对实验室指标和患者病情的监测、监护。

Objective To explore the fever with thrombocytopenia syndrome（SFTS）in patients with clinical characteristics and survival status.Methods 111 cases of SFTS were selected a retrospective analysis from January 2015 to January 2016 the hospital received in patients with clinical data.Respectively,the epidemiological characteristics of the two groups of patients with clinical features and signs,laboratory examination,treatment and outcome data were analyzed by double antigen sandwich enzyme-linked immunosorbent assay（ELISA）of SFTSV-IgG in serum antibody detection.Results 111 cases of patients with SFTS in our hospital in the treatment of patients with a total of 92 patients were completely recovered after treatment,the survival rate was 82.88%,and the mortality rate of the treatment was invalid in all of the 19 patients.SFTS incidence for 6-8 months,57.66% of the patients is mainly engaged in agricultural production and farmers living in hilly areas,the age distribution between 49-80;the clinical features of patients with high fever,headache,chills,fever and other symptoms,anorexia,nausea,vomiting,diarrhea and other gastrointestinal discomfort,fatigue,general malaise and other symptoms of infection;symptoms mainly：axillary and groin lymph node enlargement and tenderness,limb flutter laboratory examination showed increased;four patients with AST,ALT,CK index,LDH,WBC,PLT index decreased by two,and accompanied by hematuria and proteinuria.Conclusion The clinical manifestations of SFTS are various and complex,often accompanied by multiple organ damage,failure,nervous system damage,severe pulmonary infection,septic shock and other complications.Because of its poor prognosis and high mortality,it is necessary to treat the patients effectively,strengthen the monitoring and monitoring of the laboratory indexes and the patient＇s condition.