发热伴血小板减少综合征36例临床分析

Clinical analysis of 36 cases of severe fever with thrombocytopenia syndrome

目的研究发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)的临床特点,进一步指导治疗。方法选择36例在安徽省立医院住院治疗的SFTS患者作为观察对象,对其临床资料进行性回顾性分析。将其分为普通型及危重型,进一步了解年龄、血小板、白细胞计数、心肌酶谱、有无基础疾病等因素是否与疾病严重程度有相关性。结果 36例均为急性起病,病程中均有发热,分别伴有畏寒寒战、纳差乏力、腹泻、咳嗽咳痰、腔道出血及出血倾向,14例患者有不同程度的神经系统症状或体征。实验室检查提示血白细胞、中性粒细胞、血小板和白蛋白有不同程度下降,丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)和肌肌酸激酶同工酶(CK-MB)升高,血浆凝血酶原时间测定(PT)、活化部分凝血活酶时间(APTT)延长。血小板计数(PLT)≤30×10~9·L^(-1)、年龄≥60岁和神经系统损害为危重症SFTS的高危因素。27例患者病情好转后正常出院;8例患者治疗效果尚可但因经济困难自动出院;1例患者因预后差、家属放弃抢救自动出院。结论发热伴血小板减少综合征临床表现多种多样,血小板计数、年龄和神经系统损害与患者疾病严重程度有关。

Objective To study the clinical characteristics of severe fever with thrombocytopenia syndrome（ SFTS） and to further guide the treatment. Methods Thirty-six patients with SFTS in Anhui Provincial Hospital were selected as the observation object,and the clinical data were retrospectively analyzed. All the patients were divided into the general type and the critically ill type. The correlation between the different indicators（ age,platelet,leukocyte count,myocardial enzymes and basic disease） and severity of the SFTS was further evaluated. Results All the cases were acute onset,fever duration were accompanied by chills,chills,fatigue,anorexia,diarrhea,cough and expectoration,digestive tract bleeding and bleeding,14 patients with varying degrees of neurological symptoms or signs. Laboratory examination showed that the white blood cells,neutrophil,platelets,albumin has decreased in varying degrees,ALT,AST,CK,CK-MB,PT,APTT. Among them,PLT≤30 × 10~9·L^-1,age≥60 years old and neurologic damage were the high risk factor of the critical illness SFTS. 27 patients were discharged from the hospital after their condition improved,8 patients were discharged automatically due to financial difficulties,and one patient was discharged from hospital automatically due to poor prognosis. Conclusion The clinical manifestations of SFTS are various. The PLT,age,and neurologic impairment are related to the severity of the disease.