对比分析蜱传人和人传人致发热伴血小板减少综合征的临床特征及预后

Comparison of clinical features and prognosis of severe fever with thrombocytopenia syndrome transmitted from tick-to-person versus person-to-person

目的 通过对不同途径感染新型布尼亚病毒致发热伴血小板减少综合征(SFTS)的临床特征及预后影响指标分析,为该病的预防控制和判断预后提供参考依据。方法 回顾性分析皖南地区2015年1月至2020年6月新型布尼亚病毒感染致发热伴血小板减少综合征的确诊病例资料,根据有传播途径不同,分为蜱传人感染组(37例)和人传人感染组(12例),比较两组流行病学资料、临床症状、实验室检测指标及预后等差异。结果 SFTS发病集中于4-6月,人传人感染组感染途径是接触确诊患者的血液/体液;蜱传人感染组是由于户外活动被蜱虫叮咬感染。人传人感染组从发病到就诊时间中位数为2.5d,蜱传人感染组从发病到就诊时间中位数为5.0d,两组差异具有统计学意义。蜱传人感染组意识障碍比例43.2%(16/37),明显高于人传人感染组0(0/12)。人传人感染组危重症人数为16.7%(2/12),明显低于蜱传人感染组91.9%(34/37);蜱传人感染组死亡人数为29.7%(11/37),而人传人感染组无一例死亡。结论 SFTS由蜱虫叮咬感染的患者病情更重,预后不良风险更高,应针对蜱虫感染患者制定科学的防控策略和治疗方案。

Objective By analyzing the clinical features and prognostic indicators of novel phlebovirus infection in different waysinduced severe fever with thrombocytopenia syndrome(SFTS),it provides a reference for the prevention and control of the disease and early prognosis.Method Retrospective analysis of the confirmed cases of SFTS from January 2015 to June 2020 in southern Anhui,according to the different transmission routes,they were divided into tick-to-persontransmission infection group (37 cases) and person-to-person transmission infection group (12 cases).The epidemiological characteristics,clinical manifestations,blood biochemical examination and prognosis were analyzed retrospectively.Result The incidence of SFTS mainly occurred in April to June,and the infection route of the person-to-person transmission infection group was contact with the blood/body fluids of the confirmed patients.The tick-to-person transmission infection group was infected by tick bites during outdoor activities.The median time from onset to treatment was 2.5 days in person-to-person transmission infection group and 5.0 days in tick-to-person transmission infection group,the difference between the two groups was statistically significant(P<0.05).The proportion of consciousness disorder in tick-to-person transmission infection group was 43.24% (16/37) higher than that in person-to-person transmission infection group.The number of critical patients in person-to-person transmission group was 16.67%(2/12),which was significantly lower than 91.89% (34/37) in tick-to-person transmission infection group.The number of deaths in ticks-to-person transmission infection group was 29.73% (11/37),but none in person-to-person transmission infection group.Conclusion The tick-to-person transmission infection group is more serious and the risk of poor prognosis is higher,so we should scientifically formulate prevention and control strategies and treatment plans for ticks infection patients.