发热伴血小板减少综合征患者临床特征的系统分析

System analysis of clinical features of severe fever with thrombocytopenia syndrome

目的系统分析发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者的临床特征,为预防和治疗SFTS提供依据。方法检索2009年1月至2019年5月中国知网、万方数据资源库、维普期刊资源整合服务平台和PubMed、Cochrane Library、Embase数据库所收录的SFTS相关文献,对文献进行筛选,获取患者流行病学、临床表现、实验室检查、预后等资料。采用RevMan 5.2软件进行meta分析。结果本研究共纳入中文文献68篇,英文文献14篇,共有SFTS患者6780例,死亡845例(12.46%)。SFTS多发生于山地丘陵地带,职业以农民多见(3637例),发病季节多在夏季,发病高峰在每年5月至8月,1434例患者有明确蜱虫叮咬史,21例出现人传人。出现发热[89.54%(6071/6780)]、乏力[79.75%(5407/6780)]、肌肉酸痛[46.31%(3140/6780)]、畏寒[33.92%(2300/6780)]等全身中毒症状。采用随机效应模型进行meta分析,重型患者的肌酸激酶[平均差(mean difference,MD)=500.40,95%可信区间(confidence interval,CI)380.51~620.28,P<0.01]和乳酸脱氢酶水平(MD=442.81,95%CI 152.85~732.78,P=0.003)均高于轻型患者,差异均有统计学意义。年龄>60岁的患者死亡的风险增大(MD=8.19,95%CI 4.03~12.36,P<0.01)。死亡患者的肌酸激酶(MD=530.92,95%CI 29.27~1032.56,P=0.040)、乳酸脱氢酶(MD=609.28,95%CI 80.25~1138.31,P=0.020)、尿素氮(MD=4.67,95%CI 3.05~6.30,P<0.01)和肌酐(MD=43.05,95%CI 23.49~62.62,P<0.01)均高于存活患者,差异均有统计学意义。结论SFTS患者发病过程中可出现血液系统、心、肝、肾功能损伤,病死率较高。临床医师应及时监测血常规、心肌酶谱、肝肾功能等指标变化,以便尽早发现心血管等系统并发症,及时治疗,减少肝脏和心脏的损伤,降低患者病死率。

Objective To systematically analyze the clinical features of severe fever with thrombocytopenia syndrome(SFTS)and to provide evidence for the prevention and treatment of SFTS.Methods Relevant studies of SFTS from six databases,including China National Knowledge Infrastructure,Wanfang Database,Chongqing VIP,PubMed,Cochrane Library and Embase from January 2009 to May 2019 were systematically searched and identified.The literatures were screened and the data of patients′epidemiology,clinical manifestations,laboratory examinations and prognosis were obtained.Revman 5.2 software was used for meta analysis.Results Sixty-eight Chinese literatures and fourteen English literatures encompassing 6780 patients with SFTS were included in the final analysis.Of these patients,845 cases(12.46%)died.SFTS mostly occurred in mountainous and hilly areas,and farmers(3637 cases)were the usual victims.The onset season was mostly in summer and the peak was from May to August each year.There were 1434 patients had a clear history of tick bites,and 21 cases were human-to-human transmitted.There were 6071 cases(89.54%)presented with fever,5407 cases(79.75%)presented with fatigue,3140 cases(46.31%)presented with muscle soreness,and 2300 cases(33.92%)presented with chills.Using random effects model for meta analysis,the levels of creatine kinase(CK)(mean difference(MD)=500.40,95%confidence interval(CI)380.51-620.28,P<0.01)and lactic acid dehydrogenase(LDH)(MD=442.81,95%CI 152.85-732.78,P=0.003)in severe patients were both higher than those in mild patients,and the difference were both statistically significant.The risk of death increased in patients aged>60 years(MD=8.19,95%CI 4.03-12.36,P<0.01).The levels of CK(MD=530.92,95%CI 29.27-1032.56,P=0.040),LDH(MD=609.28,95%CI 80.25-1138.31,P=0.020),urea nitrogen(MD=4.67,95%CI 3.05-6.30,P<0.01)and creatinine(MD=43.05,95%CI 23.49-62.62,P<0.01)of patients in the death group were all higher than those in the survival group.The differences were all statistically significant.Conclusions During the course of SFTS,the patients may show impaired blood system,heart,liver and kidney functions with high mortality.Clinicians should timely monitor the changes of blood routine,myocardial enzyme spectrum,liver and kidney functions and other indicators,so as to find cardiovascular and other system complications as early as possible.Timely treatment could not only reduce liver,heart and other organ injuries,but also reduce mortality.