发热伴血小板减少综合征T淋巴细胞亚群特点及死亡危险因素分析

Characteristics of T-lymphocyte subsets and risk factors of death in SFTS patients

目的了解发热伴血小板减少综合症病毒(severe fever with thrombocytopenia syndrome virus,SFTSV)感染后T淋巴细胞亚群特点,探究发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者死亡危险因素。方法回顾分析2015—2018年收治的SFTS患者病例资料,根据存活/死亡分组比较患者临床症状、体征、T淋巴细胞亚群分析及其它实验室指标,通过单因素、多因素Logistic回归分析患者死亡危险因素。结果共收治SFTS患者81名,存活组66名、死亡组15名。组间性别存在统计学差异(P=0.01)。与存活组患者相比,死亡组患者ALT、AST、LDH、CK、CKMB、HBDH、TT水平明显升高,而T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数明显降低。logistic回归分析显示女性、CD4+T淋巴细胞降低、AST升高、出现意识状态改变是SFTS患者死亡的独立危险因素。结论SFTS女性患者,早期CD4+T淋巴细胞显著降低、AST明显升高、出现意识状态改变,提示病情危重,有死亡风险。女性、CD4+T淋巴细胞降低、AST升高、出现意识状态改变是SFTS死亡的独立危险因素。

Objective To investigate the characteristics of T-lymphocyte subsets in patients infected with severe fever and thrombocytopenia syndrome virus(SFTSV)and to explore the risk factors of death in patients with severe fever and thrombocytopenia syndrome(SFTS).Methods The data of patients with SFTS from 2015 to 2018 were retrospectively analyzed.The clinical symptoms,physical signs and laboratory indicators of patients in the survival/death groups were compared.The risk factors of death were analyzed by single and multivariate logistic regression.Results There were 81 patients with SFTS were involved,including 66 patients in survival group and 15 patients in death group.There was statistically significantly difference between genders in the two groups(P=0.01).Compared with the survival group,the ALT,AST,LDH,CK,CKMB,HBDH,TT levels in the death group were significantly higher,while the T-lymphocyte,CD4+T-lymphocyte and CD8+T-lymphocyte counts were significantly lower.Logistic regression results showed that women,CD4+T-lymphocyte count decreasing,AST increasing and consciousness state change were independent risk factors of death in SFTs patients.Conclusions In female patients with SFTS,CD4+T-lymphocyte decreased significantly in early stage with significant increasing of AST,and the change of consciousness state appeared,indicating the critical condition and risk of death.Female,CD4+T-lymphocyte decreasing,AST increasing and consciousness state change are independent risk factors of death by SFTS.