肾综合征出血热55例临床特征分析

Clinical Features of Hemorrhagic Fever with Renal Syndrome:an Analysis of 55 Cases

目的总结肾综合征出血热(HFRS)的临床特征,提高对本病的认识,减少漏诊。方法回顾性分析2010年1月—2016年12月郑州大学第一附属医院确诊的55例HFRS住院患者的一般资料、临床表现、实验室检查结果、并发症、治疗方法及结局,并探讨影响HFRS患者预后的因素。结果临床表现:55例患者中发热53例(96.4%),消化道症状(腹痛、腹胀、恶心、呕吐)48例(87.3%),少尿28例(50.9%),皮肤黏膜充血出血27例(49.1%),腰痛21例(38.2%),头痛20例(36.4%),休克11例(20.0%),肌肉痛9例(16.4%),眼眶痛4例(7.3%)。实验室检查结果:血小板计数减少48例(87.3%),白细胞计数升高45例(81.8%),尿蛋白阳性45例(81.8%)。并发症:肾功能不全49例(89.1%),肝损伤49例(89.1%),凝血功能障碍17例(30.9%),胰腺炎2例(3.6%),脑出血1例(1.8%)。死亡2例(3.6%)。单因素Logistic回归分析结果示休克持续时间为HFRS患者预后的危险因素[OR(95%CI)=2.078(1.008,4.282),P=0.047]。结论 HFRS出现典型临床表现者少,易并发肝脏、肾脏及血液系统不同程度损伤,休克持续时间为HFRS患者预后的危险因素。

Objective To summarize the clinical features of hemorrhagic fever with renal syndrome（HFRS）,in order to improve the understanding of this disease of healthcare providers,by which the probability of missed diagnosis can be reduced.Methods The 55 participants were enrolled from the First Affiliated Hospital of Zhengzhou University.All patients were diagnosed with HFRS and treated from January 2010 to December 2016.We retrospectively analyzed their demographic data,clinical manifestations,laboratory findings,prevalence of complications,treatment methods and outcomes,and discussed the factors associated with the prognosis of HFRS.Results Clinical manifestations：53（96.4%） with fever,48（87.3%） with gastrointestinal symptoms（abdominal pain,abdominal distension,nausea,vomit）,28（50.9%） with oliguria,27（49.1%）with dermahemia and mucosa bleeding,21（38.2%） with lumbago,20（36.4%） with headache,11（20.0%） with shock,9（16.4%） with courbature and 4（7.3%） with orbital pain.Laboratory findings：48（87.3%） with thrombocytopenia,45（81.8%）with leukocytosis,45（81.8%） with proteinuria.Prevalence of complications：49（89.1%） with renal insufficiency,49（89.1%）with liver damage,17（30.9%） with coagulopathy,2（3.6%） with pancreatitis,1（1.8%） with cerebral hemorrhage.2（3.6%）died.Univariate Logistic regression analysis revealed that the duration of shock was the risk factor for the prognosis of HFRS[OR（95%CI）=2.078（1.008,4.282）,P=0.047].Conclusion HFRS patients have less typical clinical manifestations,and they are prone to various degrees of injury in the liver,kidney and blood system.Moreover,the duration of shock is the risk factor for the prognosis of HFRS.