合肥市发热伴血小板减少综合征实验室确诊病例临床资料分析

Analysis of clinical data of laboratory confirmed cases of severe fever with thrombocytopenia syndrome in Hefei City

目的了解合肥市发热伴血小板减少综合征实验室确诊病例临床流行病学特征,为其防控工作提供科学依据。方法采用回顾性调查研究,对随机抽取20例发热伴血小板减少综合征实验室确诊死亡病例和20例确诊存活病例开展调查,分析其临床症状、暴露史、诊疗过程和实验室检测指标分布特征。结果发热伴血小板减少综合征确诊患者临床主要表现为发热(占100.0%)、乏力(占92.5%)和食欲减退(占85.0%);80.0%的患者住在丘陵或者山区,72.5%的患者病前有种地经历,12.5%的患者有明确的蜱虫叮咬史;52.5%的患者有3次及以上诊疗经历,存活和死亡患者就诊次数分布差异有统计学意义(χ_(趋势)^(2)=4.875,P=0.027);死亡和存活患者实验室检测指标中BUN(t=4.134,P<0.001)、HBDH(Z=-3.042,P=0.002)、LDH(Z=-4.366,P=0.001)、RET(Z=-2.787,P=0.005)、CKMB(Z=-1.999,P=0.046)、PLT(Z=-3.328,P=0.001)、AST(Z=-2.438,P=0.015)、UA(Z=-2.050,P=0.040)、DD(Z=-2.178,P=0.029)和CREA(Z=2.742,P=0.006)差异有统计学意义。结论发热伴血小板减少综合征患者具有户外活动的流行病学史,临床症状早期以发热、乏力为主,容易误诊;县级及以下医院诊断鉴别能力低,患者就诊次数多、确诊时间长,易延误病情,转为重症。应加强医疗机构业务培训和重点人群的健康教育,提高医院鉴别诊断能力、监测敏感性和群众防护意识。

Objective To investigate the clinical epidemiological characteristics of laboratory confirmed cases of severe fever with thrombocytopenia syndrome(SFTS),and to provide data basis for its prevention and control.Methods Retrospective investigation was used to investigate randomly selected 20 laboratory confirmed death cases and 20 confirmed surviving cases of SFTS.The clinical symptoms,exposure history,diagnosis and treatment process and the distribution characteristics of laboratory test indexes were analyzed.Results The main clinical manifestations of SFTS patients were fever(100%),fatigue(92.5%)and loss of appetite(85%).80%of the patients lived in hilly or mountainous areas,72.5%had farming experience before the disease,and 12.5%had a clear history of tick bite.52.5%of the patients had three or more diagnosis and treatment experiences.There was significant difference in the distribution of doctor visits between surviving and dead patients(χ_(tread)^(2)=4.875,P=0.027).There were significant differences in laboratory test indicators of dead and surviving patients BUN(t=4.134,P<0.001),HBDH(Z=-3.042,P=0.002),LDH(Z=-4.366,P=0.001),RET(Z=-2.787,P=0.005),CKMB(Z=-1.999,P=0.046),PLT(Z=-3.328,P=0.001),AST(Z=-2.438,P=0.015),UA(Z=-2.050,P=0.040),DD(Z=-2.178,P=0.029)and CREA(Z=2.742,P=0.006).Conclusions Most confirmed cases of SFTS in Hefei City had been exposed to rural areas.However,they are easy to be misdiagnosed because the early symptoms of SFTS mainly are fever and fatigueas.Hospitals at county level and below have low diagnostic and discriminatory capabilities.As a result,it takes patients unnecessary multiple visits to hospitals and longer diagnostic process.Patients with SFTS are more likely to be delayed treated and develop severe illness.It is essential to improve professional training for medical institutions and public health education for vulnerable population,to raise the diagnostic ability of rural hospitals and the health awareness of public.