发热伴血小板减少综合征布尼亚病毒感染患者临床诊治及死亡危险因素分析

Analysis of clinical characteristics and death risk factors in patients infected with severe fever with thrombocytopenia syndrome bunyavirus

目的总结发热伴血小板减少综合征布尼亚病毒（SFTSV）感染患者的临床特征，探讨死亡相关的危险因素。方法回顾性分析2011年5月至2016年10月收治的56例SFTSV感染患者的临床资料，比较治愈患者和死亡患者的临床表现和实验室检查结果，应用二分类Logistic回归分析影响患者死亡的危险因素。结果56例患者治愈40例，死亡16例，发病至死亡时间（12±3）d。患者均有发热、乏力等症状。26例进行骨髓穿刺检查，21例骨髓象表现为嗜血现象。与治愈患者比较，死亡患者年龄大，伴随基础疾病率高，发热时间长，皮肤和，或消化道出血、神经精神症状、肌钙蛋白异常、心律失常发生率高，血小板、CD4＋和CD8＋明显降低，活化部分凝血活酶时间（APTT）、肌酸激酶（CK）、乳酸脱氢酶（LDH）、病毒载量、丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）明显升高，差异有统计学意义（P〈0．01或0．05）。二分类Logistic回归分析结果显示，病毒载量≥5lgTCID，dml、年龄≥70岁、血小板〈20×109／L、CK〉1200U／L、发热时间〉8d、APTT≥120S、肌钙蛋白升高、神经精神症状是SFTSV感染患者发生死亡的独立危险因素（P〈0．01或〈0．05）。结论病毒载量高、年龄大、血小板降低、CK升高、发热时间长、AVIT延长、肌钙蛋白升高、神经精神症状是SFTSV感染患者发生死亡的独立危险因素，早期识别SFTSV感染患者死亡危险因素，可能有助于改善预后。

Objective The study the clinical characteristics and death risk factors in patients infected with severe fever with thrombocytopenia syndrome bunyavirus （SFTSV）. Methods The clinical data of 56 patients infected with SFTSV from May 2011 to October 2016 were retrospectively analyzed. The clinical characteristics and laboratory examination results were compared between cured patients and death patients. The death risk factors were analyzed by two classification Logistic regression analysis. Results Among the 56 cases, 40 cases were cured and 16 cases were dead, and the time of onset to death was （12 _＋ 3） d. All patients showed symptoms including fever and weakness. Bone marrow biopsy was performed in 26 cases, and hemophagocytic phenomenon was found in 21 cases. Compared with cured patients, the death patients were older; the rate of underlying diseases was higher; fever time was longer; the incidences of skin and/ or gastrointestinal bleeding, neuropsychiatric symptoms, abnormal troponin and arrhythmias were higher, platelet, CD4＊ and CD＊ were lower; the levels of activated partial thromboplastin time （APTT）, creatine kinase （CK）, lactate dehydrogenase （LDH）, viral load, alanine aminotransferase （ALT） and aspartate aminotransferase （AST） were higher, and there were statisticaldifferences （P 〈 0.01 or 〈 0.05）. Two classification Logistic regression analysis result showed that viral load≥ lgTCIDso/ml, age ≥70 years, platelet 〈 20 × 109/L, CK 〉 1 200 U/L, fever time 〉 8 d, APTT t〉 120 s, troponin elevation and neuropsychiatric symptoms were the independent risk factors of death in patients infected with SFTSV （P 〈 0.01 or 〈 0.05）. Conclusions The high viral load, high age, lower platelet, increased CK, prolonged fever time and APTT, elevated troponin and neuropsychiatric symptoms were independent risk factors of death in patients infected with SFTSV. Early identification for the risk factors of death may improve the prognosis.