新布尼亚病毒感染继发嗜血细胞综合征患者的临床及预后分析

Clinical features and prognosis of patients with secondary hemophagocytic syndrome after SFTSV infection

目的分析新布尼亚病毒感染继发嗜血细胞综合征(HPS)患者的临床特点及其与预后的相关性。方法回顾性分析2012年5月至2016年7月收治并确诊的新布尼亚病毒感染患者,选取所有行骨髓穿刺检查者32例,其中符合新布尼亚病毒感染继发HPS者25例,分析其临床特点、骨髓细胞学表现以及与预后的相关性。结果 25例患者均表现有发热、乏力、纳差,部分表现为肌肉酸痛,消化道症状,少数患者出现神经精神症状。25例患者均有WBC及PLT下降,ALT、AST、CK、LDH、D-D升高,FIB下降。骨髓细胞学检查中,25例患者均出现了程度不等的嗜血现象,以巨噬细胞吞噬红细胞和血小板较常见。结论 SFTS继发HPS患者临床表现复杂多样,HPS是SFTS的重要临床特征和常见并发症,是导致WBC、PLT下降的重要原因,可能不是SFTS死亡的独立危险因素。

Objective To analyze the clinical characteristics and prognosis of patients with secondary hemophagocytic syndrome (HPS) after SFTSV infection. Methods Among 32 patients with SFTSV infection admitted in Zhoushan Hospital from May 2012 to July 2016, HPS was confirmed in 25 cases by bone marrow puncture. The clinical data of 25 patients with secondary HPS after SFTSV infection were analyzed retrospectively. Results All 25 cases presented with fever, fatigue,anorexia, leucopenia and thrombocytopenia, most of cases presented myalgia and gastrointestinal symptoms, and few presented with neuropsychiatric symptoms. ALT, AST, CK, LDH, D-D were increased and FIB decreased in all patients.Various degree of hemophgocytosis was presented in the bone marrow cytology, and macrophages phagocytosis of erythrocytes and platelets were common. Conclusion Secondary HPS is common complication for SFTSV patients which has various clinical manifestations, and may result in leucopenia and thrombocytopenia, but may not increase the mortality of patients.