69例发热伴血小板减少综合征临床特点及预后影响因素的调查研究

Investigation of clinical characteristics and prognosis of severe fever with thrombocytopenia syndrome: 69 cases analysis

目的分析安徽医科大学第二附属医院收治发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者的临床特点及预后影响因素。方法纳入2012年1月~2016年9月入院的SFTS患者,按预后将其分为存活组和死亡组,进行数据采集和分析。结果纳入69例合格病例,存活组49例,死亡组20例,病死率为28.99%。高龄、存在呼吸道、消化道、神经系统及出血表现者病死率高(均有P<0.05)。两组间白细胞计数、血小板计数、血清肌酐、谷草转氨酶(aspartate transaminase,AST)、心肌型肌酸激酶同功酶(MB isoenzyme of creatine kinase,CKMB)和乳酸脱氢酶(lactate dehydrogenase,LDH)水平差异均有统计学意义(均有P<0.05)。死亡组入院48 h序贯器官衰竭(sequential organ failure assessment,SOFA)评分高于存活组(Z=-6.495,P<0.001)。多因素Logistic回归分析显示神经系统症状和出血表现是SFTS患者的独立预后影响因子。结论 SFTS患者的白细胞计数、血小板计数、血清肌酐、AST、CKMB和LDH水平与预后密切相关,其预后独立影响因子为神经系统症状和出血表现,建议诊疗过程中使用SOFA评分指导病情和预后判断。

Objective To investigate the clinical characteristics and prognostic factors of severe fever with throm- bocytopenia syndrome （SFTS） patients from, the Second Affiliated Hospital of Anhui Medical University. Methods Clinical data of SFTS patients from January 2012 to September 2016 were reviewed and compared. According to prognosis, all cases were divided into survival group and death group, The clinical characteristics and prognostic factors of SFTS patients were analyzed. Results A total of 69 SFTS ：patients were included with 49 cases in survival group and 20 cases in death group. The case fatality rate was 28.99%. The advanced age and symptoms of respiratory system, gastrointestinal system, neurological system and hemorrhage in death group were significantly higher than that in survival group （ all P 〈 0. 05）. There were significant differences between the two groups in neutrophil count, platelet count, aspartate transaminase （AST）, MB isoenzyme of creatine kinase （CKMB） , and lactate dehydrogenase （LDH） （all P 〈0. 05）. The sequential organ failure assessment （SOFA） in death group was significantly higher than that in the survival group （Z = - 6. 495, P 〈 0.001 ）. Multiple factor Logistic regression analysis showed that,the independent prognostic factors included neurological system symptoms and hemorrhage. Conclusions The level of neuirophil count, platelet count, serum creatinine, AST, CKMB and LDH are associated with the prognosis of SFTS. The independent prognostic factors are neurological system symptoms and hemorrhage. SOFA should be recommended during the evaluation and treatment of SFTS patients.