新型布尼亚病毒感染患者25例临床特征及预后因素分析

Clinical characteristics and prognostic factors of 25 patients with new bunyavirus infection

目的探讨新型布尼亚病毒感染的临床特点及其预后相关影响因素。方法选取金华地区2011年8月至2017年12月确诊的新型布尼亚病毒感染患者25例,根据患者的生存情况,将25例患者分为痊愈组(15例)与死亡组(10例)。比较痊愈组和死亡组患者的一般资料,症状体征,实验室检查包括白细胞计数、中性粒细胞、血红蛋白、血小板计数、总胆红素、直接胆红素、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、AST/ALT、肌钙蛋白I、乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶(CK-MB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体、肌酐及尿蛋白,治疗及预后情况,采用受试者工作特征(ROC)曲线分析预后的相关影响因素。结果痊愈组出现意识障碍患者显著低于死亡组(1/15 vs.7/10,P=0.002),AST/ALT[1.80(1.38,3.16)vs.3.27(1.97,4.84),H=1.997,P=0.046]、肌钙蛋白I[0.04(0.02,0.25)ng/L vs.0.63(0.49,1.19)ng/L,H=3.328,P=0.001]、肌酸激酶[836.00(318.00,1 462.00)U/L vs.2 486.00(590.25,3 417.00)U/L,H=2.302,P=0.021]、CK-MB[33.00(25.00,52.00)U/L vs.66.50(38.25,104.50)U/L,H=1.970,P=0.049]、PT[11.70(10.90,12.20)s vs.14.35(12.53,15.63)s,H=2.719,P=0.007]及APTT[44.70(34.20,53.20)s vs.79.00(60.05,105.55)s,H=3.439,P=0.001]表达水平亦均显著低于死亡组。将AST/ALT、肌钙蛋白I、肌酸激酶、CK-MB、PT及APTT纳入ROC曲线分析,结果显示,AST/ALT[曲线下面积(AUC)=0.740,95%置信区间(CI)(0.525,0.955),P=0.046]、肌钙蛋白I[AUC=0.900,95%CI(0.777,0.987),P=0.001]、肌酸激酶[AUC=0.777,95%CI(0.570,0.983),P=0.021]、CK-MB[AUC=0.737,95%CI(0.519,0.954),P=0.049]、PT[AUC=0.817,95%CI(0.654,0.923),P=0.007]及APTT[AUC=0.913,95%CI(0.804,0.993),P=0.001]均对新型布尼亚病毒感染患者预后具有预测价值。其中,肌钙蛋白I和APTT的AUC分别为0.900和0.913,对预后的预测能力均较好。结论金华地区人感染新型布尼亚病毒患者多病情重、死亡比例高、临床症状多样,其中AST/ALT、肌钙蛋白I、肌酸激酶、CK-MB、PT及APTT是预后的重要影响因素。

Objective To investigate the clinical characteristics and prognostic factors of patients with the new type of bunyavirus infection.Methods A total of 25 patients with new bunyavirus infection diagnosed in Jinhua area between August 2011 and December 2017 were selected.According to their survival,25 patients were divided into the cure group(15 cases)and death group(10 cases).The general data,symptoms and signs,laboratory tests including the leucocyte count,neutrophile granulocyte,hemoglobin,platelet count,total bilirubin,direct bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),AST/ALT,troponin I,lactic dehydrogenase,creatine kinase,creatine kinase isoenzyme(CK-MB),prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer,creatinine,and urinary protein,treatment and prognosis were compared between the cure group and death group,and the related factors of prognosis were analyzed using the receiver operating characteristic(ROC)curve.Results Patients with consciousness disorder in the cure group were significantly fewer than those in the death group(1/15 vs.7/10,P=0.002).The AST/ALT[1.80(1.38,3.16)vs.3.27(1.97,4.84),H=1.997,P=0.046],troponin I[0.04(0.02,0.25)ng/L vs.0.63(0.49,1.19)ng/L,H=3.328,P=0.001],creatine kinase[836.00(318.00,1 462.00)U/L vs.2 486.00(590.25,3 417.00)U/L,H=2.302,P=0.021],CK-MB[33.00(25.00,52.00)U/L vs.66.50(38.25,104.50)U/L,H=1.970,P=0.049],PT[11.70(10.90,12.20)s vs.14.35(12.53,15.63)s,H=2.719,P=0.007]and APTT[44.70(34.20,53.20)s vs.79.00(60.05,105.55)s,H=3.439,P=0.001]in the cure group were also significantly lower than those in the death group.AST/ALT,troponin I,creatine kinase,CK-MB,PT and APTT were included in the ROC analysis.The results showed that AST/ALT[area under the curve(AUC)=0.740,95%confidence interval(CI)(0.525,0.955),P=0.046],troponin I[AUC=0.900,95%CI(0.777,0.987),P=0.001],creatine kinase[AUC=0.777,95%CI(0.570,0.983),P=0.021],CK-MB[AUC=0.737,95%CI(0.519,0.954),P=0.049],PT[AUC=0.817,95%CI(0.654,0.923),P=0.007]and APTT[AUC=0.913,95%CI(0.804,0.993),P=0.001]had predictive value for the prognosis of patients with the new type of bunyavirus infection.The AUCs of troponin I and APTT were 0.900 and 0.913,respectively,both of which can predict prognosis.Conclusions In Jinhua area,patients infected with the new type of bunyavirus had more serious illnesses,high mortality and various clinical symptoms.Among them,AST/ALT,troponin I,creatine kinase,CK-MB,PT and APTT are important prognostic factors.