发热伴血小板减少综合征重症患者的早期预警指标分析

Analysis of Early Warning Indicators for Severe Fever with Thrombocytopenia Syndrome

目的探讨发热伴血小板减少综合征(SFTS)重症患者的早期预警指标,为SFTS患者的早期干预提供预警。方法回顾性分析2019年5月~2020年10月安徽医科大学附属巢湖医院收治的80例确诊SFTS患者的临床资料,根据患者的病情进展及预后分为轻症组(42例)和重症组(38例),分析其流行病学资料,比较两组临床表现、实验室检查结果,运用多因素Logistic回归分析早期重症化预警因素。结果80例患者均为散发病例,发病时间呈全年散发,春夏季节多发,发病高峰主要集中在5~9月份,且所有患者均在发病后的3~4 d内入院治疗。重症组皮肤出血点,口腔出血,神志改变发生率高于轻症组,差异有统计学意义(P<0.05)。重症组ALT、AST、LDH、CK、CK-MB、淀粉酶、脂肪酶、肌酐、APTT、PT、D-二聚体高于轻症组,WBC、PLT低于轻症组,差异有统计学差异(P<0.05);重症组SFTSV核酸定量高于轻症组,差异有统计学意义(P<0.05)。Logistic回归分析显示,神志改变、血小板<50×109/L、肌酶>5 ULN、SFTSV核酸定量>105 copies/ml具有早期预警作用。结论神志改变、实验室指标和血清布尼亚病毒核酸定量异常升高是SFTS患者重症化早期预警的有效指标,应重点关注上述指标,于疾病早期对可能进展为重症的SFTS患者采取有效、积极的预防及治疗手段。

Objective To explore the early warning indicators of severe patients with fever with thrombocytopenia syndrome(SFTS),and to provide early warning for early intervention of SFTS patients.Methods The clinical data of 80 patients with confirmed SFTS admitted to Chaohu Hospital of Anhui Medical University from May 2019 to October 2020 were retrospectively analyzed.The patients were divided into mild group(42 cases)and severe group(38 cases)according to their disease progression and prognosis,and their epidemiological data were analyzed.The clinical manifestations and laboratory test results of the two groups were compared,and multivariate Logistic regression was used to analyze the early warning factors of severe illness.Results All 80 patients were sporadic cases.The onset time was sporadic throughout the year,and frequently occurred in spring and summer.The peak incidence was mainly concentrated in May to September,and all patients were admitted to the hospital within 3 to 4 d after the onset.The incidence of skin bleeding,oral bleeding,and mental changes in the severe group was higher than that in the mild group,the difference was statistically significant(P<0.05).Severe group ALT,AST,LDH,CK,CK-MB,amylase,lipase,creatinine,APTT,PT,D-dimer are higher than mild group,WBC and PLT are lower than mild group,the difference was statistically different(P<0.05);The quantitative nucleic acid of SFTSV in the severe group was higher than that in the mild group,the difference was statistically significant(P<0.05).Logistic regression analysis showed that mental changes,platelets<50×109/L,muscle enzymes>5 ULN,and SFTSV nucleic acid quantification>105 copies/ml have early warning effects.Conclusion Mental changes,laboratory indexes and abnormal increase of serum bunyavirus nucleic acid are effective indicators for early warning of severe SFTs.We should pay attention to the above indexes and take effective and active prevention and treatment measures for SFTs patients who may progress to severe disease in the early stage of the disease.