53例肾综合征出血热的临床特征及误诊分析

Analysis of Clinical Features and Misdiagnosis of 53 Cases of Hemorrhagic Fever with Renal Syndrome

目的:分析肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)的临床特征及误诊原因,为HFRS的早期诊断提供参考依据,减少误诊。方法:回顾分析本院2017年1月至2019年12月收治的53例确诊为HFRS患者临床病历的流行病学资料、临床症状和体征、实验室检查、误诊情况等。结果:53例HFRS患者居住广州,男女比为4.3∶1.0(43∶10),年龄为(42.54±13.90)岁。HFRS全年散发,23例流行病学史清晰,其居所或工作场所有老鼠出没。入院当天临床症状中发热症状最多见,占98.1%,47例出现肌痛、头痛、腰痛、眼眶痛,17例出现局部皮肤黏膜充血潮红,具有典型"三红三痛"临床表现病例仅为1例,占1.9%。实验室检查:血小板降低为44例(83.0%);肌酐升高为33例(62.3%);尿蛋白阳性为41例(77.4%);谷丙/谷草转氨酶升高31例(58.5%)。临床分型以轻型为主,占35例(66.1%)。首诊误诊病例共13例,误诊率24.5%。结论:HFRS临床特征复杂多样,具有典型临床表现者少,容易出现多器官功能损害,易误诊。临床医生需提高对该病的认识,减少误诊,争取早发现、早诊断、早治疗。

Objective:To analyze the clinical features and causes of misdiagnosis of hemorrhagic fever with renal syndrome(HFRS)in order to provide a reference for the early diagnosis of HFRS and reduce misdiagnosis. Methods:To retrospectively analyze the epidemiological data,clinical symptoms and signs,laboratory examinations,misdiagnosis,etc. of the clinical record data of 53 patients with HFRS admitted to our hospital from January 2017 to December 2019.Results:53 HFRS patients lived in Guangzhou,the male to female ratio was 4.3∶1.0(43∶10),and the age was(42.54±13.90)years old. HFRS is distributed throughout the year,23 cases have a clear epidemiological history,and there are rats in their homes or workplaces. Fever was the most common clinical symptom on the day of admission,accounting for 98.1%. 47 cases had myalgia,headache,low back pain,or orbital pain,and 17 cases had local skin and mucous membrane congestion and flushing. The clinical manifestations of"three reds and three pains"were typical. The medical record was only 1 Cases,accounting for 1.9%. Laboratory examination:decreased platelets in 44 cases(83.0%);increased creatinine in 33 cases(62.3%);positive urinary protein in 41 cases(77.4%);elevated glutamate/aspartate aminotransferase in 31 cases(58.5%). The clinical classification was mainly mild,accounting for 35 cases(66.1%).A total of 13 misdiagnosed cases occurred in the first diagnosis,and the misdiagnosis rate was 24.5%. Conclusion:The clinical features of HFRS are complex and diverse,with few typical clinical manifestations,multiple organ dysfunction,and misdiagnosis. Clinicians need to improve their understanding of the disease,reduce misdiagnosis,and strive for early detection,early diagnosis,and early treatment.