深圳市46例肾综合征出血热患者流行病学和临床特点分析

An analysis of epidemiological and clinical features of 46 patients with hemorrhagic fever with renal syndrome in Shenzhen City

目的了解深圳市肾综合征出血热(HFRS)患者流行病学特征和临床特点,积累本地区HFRS诊治经验。方法采用回顾性分析,收集2015年1月至2018年12月深圳市人民医院感染病科收治的46例确诊HFRS患者临床病历资料,分析患者人口学特征、流行病学特点、临床表现、检验检查、诊疗转归等。结果46例HFRS患者均定居深圳市,男女性别比为6.67∶1.00(40∶6),年龄为(40.18±15.63)岁,23~45岁者38例(82.61%)。41例(89.13%)有HFRS流行病学史,其家庭或工作场所有老鼠。39例(84.78%)患者租房居住,其中34例(87.18%)租住城中村。全年均有发病,以1-6月为发病高峰(33例,71.74%)。临床分型:轻型44例(95.65%),中型2例(4.35%),无重型和危重型患者。临床表现特点:全部患者因发热入院,39例(84.78%)出现全身酸痛、头痛、腰痛和眼眶痛,28例(60.87%)皮肤黏膜充血潮红。临床分期显示,全部患者均有发热期和多尿期,其中发热期为(7.34±6.82)d,多尿期为(9.94±5.77)d,仅4.35%(2/46)的患者出现低血压休克期,所有患者均未出现少尿期。入院次日血常规中白细胞为(8.17±3.19)×10^9个/L,在正常范围的患者38例(82.61%);血小板为(61.92±32.53)×10^9个/L,降低42例(91.30%);降钙素原为(1.62±0.38)ng/ml,升高41例(89.13%);C反应蛋白为(74.33±30.48)mg/L,均升高(100.00%);肌酐为(176.25±55.15)μmol/L,升高19例(41.30%)。肝功能异常表现为酶学升高,谷丙转氨酶为(137.58±46.76)U/L,谷草转氨酶为(129.82±40.29)U/L。全部患者汉坦病毒IgM阳性。58.70%(27/46)的患者肾脏B超显示双肾饱满、实质回声增强。39例(84.78%)患者出现肝损伤,2例(4.35%)窦性心动过缓。46例患者均临床治愈。结论深圳市HFRS患者流行病学特点典型、病情轻、疗效和转归好。

Objective To understand the epidemiological and clinical features of patients with hemorrhagic fever and renal syndrome(HFRS)in Shenzhen,and to accumulate experience in the diagnosis and treatment of HFRS in this area.Methods A retrospective analysis was conducted by collecting the clinical data from 46 patients who were confirmed with HFRS and admitted to the Department of Infectious Diseases of Shenzhen People's Hospital from January 2015 to December 2018.The demographic characteristics,epidemiological,clinical manifestations,examinations,treatments and prognosis,and other characteristics were analyzed.Results All the 46 patients with HFRS were residens in Shenzhen,with a male-to-female ratio of 6.67∶1.00(40∶6),aged(40.18±15.63)years old,and 38 patients(82.61%)aged 23-45 years old.There were 41 patients(89.13%)with a history of HFRS epidemiology,and there were mice in their houses or workplaces.The houses of 39 patients(84.78%)were rented,and 34 patients(87.18%)rented their houses in urban villages.There were morbidity throughout the year,and 33 patients(71.74%)were ill from January to June.In clinical classification,44 cases(95.65%)were mild,2 cases(4.35%)were medium,and there were no severe or critical cases.The clinical manifestations were that all patients were hospitalized due to fever mainly with hyperthermia.Thirty-nine patients(84.78%)were presented with systemic aches,headaches,low back pain and eyelid pain,and 28 patients(60.87%)had skin and mucous membrane hyperemia flushing.Clinical stages showed that all patients had pyretogenesis stage and polyuria stage,including pyretogenesis stage[(7.34±6.82)d],polyuria stage[(9.94±5.77)d],only 4.35%(2/46)patients with hypotension shock stage,all patients did not have oliguric stage.On the next day of admission,the number of white blood cells in 46 patients was(8.17±3.19)×10^9/L,and 38 cases(82.61%)in the normal range;platelet was(61.92±32.53)×10^9/L,and 42 cases(91.30%)were decreased;the procalcitonin was(1.62±0.38)ng/ml,and 41 cases(89.13%)were increased;C-reactive protein was(74.33±30.48)mg/L,and 46 patients(100.00%)were elevated;creatinine was(176.25±55.15)μmol/L,and 19 cases(41.30%)were increased.Abnormal liver function was manifested by increased enzymology,alanine aminotransferase was(137.58±46.76)U/L,and aspartate aminotransferase was(129.82±40.29)U/L.All patients were positive for Hantavirus IgM.B-ultrasound results showed that in 58.70%(27/46)patients,both kidneys were plump and the parenchymal echo was enhanced.Liver injury occurred in 39 patients(84.78%)and sinus bradycardia in 2 patients(4.35%).All the 46 patients were clinically cured.Conclusion The epidemiological characteristics of patients with HFRS in Shenzhen are typical,the clinical manifestations are mild,and the curative effect and prognosis are good.