发热伴血小板减少综合征神经系统损害78例临床特征及预后分析

Clinical features and prognosis analysis of 78 cases of nervous system injury with febrile thrombocytopenia syndrome

目的:探讨发热伴血小板减少综合征(SFTS)伴神经系统损害的临床特点。方法:选择2012年6月—2018年9月治疗的SFTS伴神经系统损害的患者78例,分析临床特点及辅助检查结果。结果:SFTS伴神经系统损害症状主要表现方式为精神萎靡不振(89.7%)、伸舌震颤(29.5%)、下颌震颤(23.1%)、四肢不自主抖动(24.4%)、反应迟钝(3.8%)、躁动不安(3.8%)、四肢频繁抽搐(3.8%)、神志恍惚或昏迷(19.2%)、一过性意识障碍、言语不清(1.3%);辅助检查结果:血小板(PLT)、白细胞(WBC)均有不同程度下降,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)、血肌酐(SCr)、乳酸脱氢酶(LDH)升高。心电图及脑电图表现无特异性。78例患者均积极治疗,16例(20.5%)患者因病情危重死亡。结论:SFTS伴神经系统损害症状表现方式多种多样,高龄、意识障碍、高LDH、高CK对于SFTS伴神经系统损害有预测价值。

Objective:To understand the main manifestations of severe fever with thrombocytopenia syndrome neurological damage caused by the new type of bunya virus infection,early intervention was performed to reduce the fatality rate.Methods:Clinical features,laboratory examination and prognosis of 78 patients with laboratory-confirmed novel bunya virus infection complicated with neurological damage were retrospectively analyzed.Results:Symptoms of SFTS with nervous system damage are mainly manifested as lack of energy(89.7%),tongue extension tremor(29.5%),mandibular tremor(23.1%),involuntary limb vibration(24.4%),unresponsiveness(3.8%),restless restlessness(3.8%),frequent twitching of limbs(3.8%),trance or coma(19.2%),transient disturbance of consciousness,slurred speech(1.3%).Results of auxiliary tests:platelets(PLT),white blood cells(WBC) They all decreased to varying degrees,and alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatine kinase(CK),blood creatinine(SCr),and lactate dehydrogenase(LDH) increased.ECG and EEG showed no specificity.78 patients were actively treated and 16 patients(20.5%) died due to critical illness.Conclusion:The main manifestations with thrombocytopenia syndrome neurological damage of SFTS are various.The high CK,high LDH,age and neurologic impairment are related to the severity of the disease.