发热伴血小板减少综合征布尼亚病毒载量与患者病情相关性研究

Study on the relationship between viral load of severe fever with thrombocytopenia syndrome bunyavirus and patient＇s condition

目的探讨发热伴血小板减少综合征病毒（SFTSV）在人体内存在的时限、SFTSVRNA载量与病情的严重程度及预后的相关性。方法回顾性分析山东省威海市中心医院2015年5月至2016年10月住院125例SFTS患者的临床资料，并根据SFTSVRNA载量分为低病毒载量组和高病毒载量组，比较两组神经系统症状、出血倾向、严重心肌损害和肺炎的发生率，实验室生物化学指标差异及预后的相关性，并对其中46例进行SFTSVRNA载量动态检测。计数资料采用y。检验；正态分布的计量资料采用t检验，非正态分布采用秩和检验。结果125例患者男64例，女61例，平均年龄（59．0±3．6）岁，治愈101例，死亡24例。低病毒载量组81例，SFTSVRNA载量为（3．08±1．01）拷贝／mL；高病毒载量组有44例，SFTSVRNA载量为（5．69±0．99）拷贝／mL，两组SFTSVRNA载量比较差异有统计学意义（t=11．78，P〈0．05）。46例患者SFTSVRNA载量动态检测结果显示，发病1周后多数患者的病毒量开始下降，至发病23d后，均转为阴性。两组患者神经系统症状、出血倾向、严重心肌损害及肺炎的发生率比较差异均有统计学意义（y。值分别为92．987、38．711、75．889和54．680，均P〈0．05）。死亡患者SFTSVRNA载量为1．06×10^4～5．78×10^7拷贝／mL。两组患者白细胞计数比较差异无统计学意义（t=0．181，P〉0．05），而血小板计数比较差异有统计学意义（t=2．869，P〈0．05）；两组患者AST、rGT比较差异均有统计学意义（P值分别〈0．01和0．05）；两组患者CK、CK—MB、乳酸脱氢酶（LDH）和羟丁酸脱氢（HBDH）比较差异均有统计学意义（P值分别〈0．05或0．01）；两组患者血钠、血钙和血糖比较差异均有统计学意义（P值分别〈0．01或0．05）；两组患者活化部分凝血酶时间（APTT）比较差异有统计学意义（t=5，623，P〈0．01）。结论SFTSV感染发病后，病毒在体内存在的时间可能〈4周。SFTSVRNA载量与病情严重程度及预后密切相关，FTSVRNA载量越高，患者脏器损害越重，死亡率越高。

Objective To explore the severe fever with thrombocytopenia syndrome bunyavirus （SFTSV） existence time in the body, and the correlation between viral load and the severity and prognosis of disease. Methods The clinical data of 125 SFTS patients from May 2015 to October 2016 in Weihai Central Hospital in Shandong province were analyzed retrospectively. Patients were divided into low viral load group and high viral load group according to the SFTSV RNA levels. Neurological symptoms, bleeding tendency, the incidence of myocardial damage and severe pneumonia, laboratory biochemical index and prognosis of two groups were compared. SFTSV RNA of 46 cases were detected dynamically. Data with homogeneity of variance were tested by t test, and data with heterogeneity of variance was tested by rank sum test. Results Among the 125 cases, 64 were male and 61 were female. The mean age was （59.0±3.6） years old. One hundred and one cases were cured, and 24 died. SFTSV RNA loads in low viral load group（ 81 cases） were （3.08±1.01） copies/mL, and those in high viral load group （44 cases） were （5.69±0.99） copies/mL, with statically significant difference （t=11.78, P〈0.05）. By the dynamic detection of SFTSV RNA load in 46 patients, viral loads in most patients were gradually declined after 1 week of onset, and cleared after 23 days. The incidence of neurological symptoms, bleeding tendency, severe myocardial damage and pneumonia of two groups showed significant difference （Z2 = 92. 987, 38. 711, 75. 889 and 54. 680,respectively, all P〈0.05）. The viral loads of patients who died varied from 1.06X 104 copies/mL to 5.78X 107 copies/mL. White blood counts of two groups showed no significant difference （t=0. 181, P〉0.05）. The platelet counts of two groups had significant difference （t= 2. 869, P〈0. 05）. AST and γ-GT of two groups also had significant difference （P〈0. 01 and 0. 05, respectively）, creatine kinase, creatine kinase isoenzyme, lactic dehydrogenase and hydroxybutyrate dehydrogenase of two groups all had significant difference （P〈0. 01 or 0.05）. Serum sodium, blood calcium and glucose of the two groups had significant difference （P〈0.01 or 0. 05）. activated partial thromboplastin time of the two groups showed significant difference as well （t = 5. 623, P〈 0. 01）. Conclusions After the onset of SFTSV infection, the virus existence in the body may less than 4 weeks. Viral loads are closely associated with disease severity and prognosis. The higher the viral loads are, the heavier organ dysfunction could be and the higher mortality is.