发热伴血小板减少综合征临床及影像表现分析

Analysis of Clinical and Imaging Manifestations of Fever with Thrombocytopenia Syndrome

目的探讨发热伴血小板减少综合征(SFTS)的临床表现和影像学特点。方法选择2015年7月~2019年8月我院90例确诊为SFTS患者的临床及影像学资料,根据预后分为预后良好组(74例)和预后不良组(16例),比较两组临床表现及实验室指标,采用Logistic回归分析SFTS预后不良的危险因素,总结SFTS的影像学特征。结果预后不良组消化道出血及中枢神经系统症状发生多于预后良好组,差异有统计学意义(P<0.05);两组血小板、D-二聚体、乳酸脱氢酶、肌酸激酶同工酶、谷草转氨酶、尿酸及血肌酐水平比较,差异有统计学意义(P<0.05);Logistic回归分析显示,中枢神经系统症状是影响SFTS患者预后的危险因素(OR=7.708,95%CI:1.692~35.114);85例患者胸部CT平扫表现包括双肺索条(49.41%),胸腔积液(51.76%),腋窝淋巴结肿大(18.82%);78例患者腹部CT表现包括胰周渗出(3.85%),腹腔积液(11.54%);31例盆腔CT扫描显示腹股沟淋巴结肿大(70.97%)。结论发热伴血小板减少综合征实验室指标水平过高可能提示预后不良,中枢神经系统症状是SFTS预后不良的独立危险因素,其影像表现双肺伴或不伴渗出性病变,胸腔积液,浅表淋巴结肿大。

Objective To explore the clinical manifestations and imaging features of fever with thrombocytopenia syndrome(SFTS).Methods The clinical and imaging data of 90 patients diagnosed with SFTS in our hospital from July 2015 to August 2019 were selected and divided into good prognosis group(74 cases)and poor prognosis group(16 cases)according to prognosis.Performance and laboratory indicators,using Logistic regression to analyze the risk factors of poor prognosis of SFTS,summarize the imaging characteristics of SFTS.Results Gastrointestinal bleeding and central nervous system symptoms occurred in the poor prognosis group more than the good prognosis group,the difference was statistically significant(P<0.05);platelets,D-dimer,lactate dehydrogenase,creatine kinase isoenzymes in the two groups,Aspartate aminotransferase,uric acid and blood creatinine levels were compared,the difference was statistically significant(P<0.05);Logistic regression analysis showed that the central nervous system symptoms are risk factors affecting the prognosis of SFTS patients(OR=7.708,95%CI:1.692~35.114);85 patients with chest CT plain scan including double lung cord(49.41%),pleural effusion(51.76%),axillary lymphadenopathy(18.82%);78 patients with abdominal CT manifestation including peripancreatic exudation(3.85%),peritoneal effusion(11.54%);31 cases of pelvic CT scan showed inguinal lymphadenopathy(70.97%).Conclusion Fever with excessively high laboratory index levels of thrombocytopenia syndrome may indicate a poor prognosis.Central nervous system symptoms are independent risk factors for poor prognosis of SFTS.The imaging findings show double lungs with or without exudative lesions,pleural effusion,and shallow enlarged lymph nodes.