新型布尼亚病毒感染患者临床特征及其预后因素分析

Clinical characteristics and prognostic factors of patients infected with novel Bunyavirus

目的通过分析新型布尼亚病毒感染患者的临床特征、流行病学特点及其预后影响因素,为该病的诊疗及防控提供参考依据。方法收集202例确诊为新型布尼亚病毒感染患者的病例资料进行回顾性分析,根据患者的预后情况,分为存活组(n=164)及死亡组(n=38)。比较存活组和死亡组患者的一般资料、临床表现、实验室检查指标(24 h内);针对两组资料在单因素分析基础上进行多因素Logistic回归分析,得出新型布尼亚病毒感染患者死亡的独立影响因素。结果202例新型布尼亚病毒感染患者,均为病毒核酸检测阳性和(或)病毒抗体检测阳性的病例,其中男性86例、女性116例,年龄52~73(62.8±10.6)岁;与死亡组比较,存活组年龄小、热程短,差异有统计学意义(P<0.05);而两组病例性别、地区、职业、发病距离就诊时间、虫咬史等差异无统计学意义。两组患者临床症状(发热、颈亢、头痛、乏力、纳差、恶心、腹泻、呕吐、咳嗽、肌肉酸痛、寒战、淋巴结肿大、腹部不适等)差异均无统计学意义。死亡组合并急性胰腺炎、中枢神经系统损害、出血、心肌损害、心律失常比例明显高于存活组,差异有统计学意义(P<0.01)。死亡组患者血液中病毒载量、铁蛋白、乳酸脱氢酶(LDH)等指标均明显高于存活组,而淋巴细胞计数、血小板、Th细胞计数、IgM阳性率均低于存活组,差异有统计学意义(P<0.01)。其中,热程、年龄、淋巴细胞计数、活化部分凝血活酶时间(APTT)为患者死亡的独立影响因素。结论新型布尼亚病毒感染患者年龄大、热程长、血液APTT明显延长、血液淋巴细胞计数低提示患者预后不良。

Objective To provide references for the diagnosis,treatment,prevention and control of the disease by analyzing the clinical characteristics,epidemiological characteristics and prognostic factors of patients infected with novel Bunyavirus.Methods Retrospective analysis was performed on 202 patients infected with novel Bunyavirus.According to the prognosis of the patients,the patients were divided into the survival group(n=164)and the death group(n=38).The general data,clinical manifestations,and laboratory test indicators of patients in the survival group and the death group(within 24 hours)were compared.Multivariate Logistic regression analysis was conducted on the basis of univariate analysis for the two groups of data,and the independent influencing factors of mortality of patients infected with Bunyavirus were obtained.Results Among the 202 confirmed cases,86 were male and 116 were female,aged 52~73(62.8±10.6)years.The survival group was significantly younger than the death group,and the heat course was significantly longer than that of the survival group(P<0.05).However,there was no statistically significant difference between the two groups in terms of gender,region,occupation,onset distance to visit the doctor,insect bite history,etc.There was no significant difference in clinical symptoms(fever,hyperneckiness,headache,fatigue,insufficiency,nausea,diarrhea,vomiting,cough,muscle aches,shivers,lymph node enlargement,abdominal discomfort,etc.)between the two groups.The proportion of acute pancreatitis,central nervous system damage,bleeding,myocardial damage and arrhythmia in the death group was significantly higher than that in the survival group(P<0.01).In the death group,viral load,ferritin,lactic lehydrogenase(LDH)and other indicators were significantly higher than those in the survival group,while lymphocyte count,platelet count,Th cell count and IgM positive rate were all lower than those in the survival group(P<0.01).Among them,thermal course,age,lymphocyte count and active partial thromboplastin time(APTT)were independent influencing factors of death.Conclusion The older the age,the longer the heat course,the longer the APTT and the lower the lymphocyte count,the worse the prognosis of the patients infected with the novel Bunyavirus.