发热伴血小板减少综合征患者临床特征分析

Analysis of clinical characteristics of patients with severe fever with thrombocytopenia syndrome

目的分析发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)重症监护室(ICU)组和非ICU组患者临床和实验室指标差异,筛选出具有较高价值的预测指标。方法回顾性收集2019年6月到12月在济南市某医院经实验室确诊的69例SFTS患者的临床和实验室指标资料,根据患者临床转归分为ICU和非ICU组,分析两组患者临床表现、实验室指标差异,通过受试者工作特征(ROC)曲线筛选价值较大的预测指标。结果与非ICU组相比,ICU组SFTS患者的降钙素原(PCT)、C反应蛋白(CRP)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP),谷氨酰转肽酶(GGT)、亮氨酸氨基肽酶(LAP)、谷氨酸脱氢酶(GDH)、腺苷脱氨酶(ADA)、胱抑素C(Cys C)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶(CK)和乳酸脱氢酶(LDH)水平显著更高(W=530.0,P=0.003;W=496.5,P=0.015;W=496.0,P=0.015;W=535.5,P=0.002;W=545.5,P=0.001;W=498.5,P=0.013;W=537.0,P=0.002;W=523.0,P=0.004;W=512.0,P=0.007;W=502.0,P=0.012;W=486.0,P=0.023;W=509.0,P=0.008;W=541.0,P=0.002),而血小板计数(PLT)、间接胆红素(IBIL)、白球比(A/G)、前白蛋白(PALB)和超氧化物歧化酶(SOD)水平更低(W=199.0,P=0.024;W=175.5.5,P=0.009;t=-2.9,P=0.004;W=209.5,P=0.036;t=-3.0,P=0.004)。ROC结果显示,ALP[曲线下面积(area under the curve,AUC)=0.804,95%置信区间(confidence interval,CI)(0.679~0.929)]和LDH[AUC=0.805,95%CI(0.680~0.930)]预测重症风险价值较高。结论SFTS患者肝功能、心功能和肾功能指标异常提示患者有病情加重风险,其中ALP和LDH水平预测重症风险价值较高,提示在临床护理过程中,应加强对具有上述症状患者的监测。

Objective We try to screen out predictive indicators with higher value by analyzing the differences in clinical and laboratory indicators between severe fever with thrombocytopenia syndrome(SFTS)patients in the intensive care unit(ICU)group and non-ICU group.Methods The clinical and laboratory index data of 69 SFTS patients diagnosed in the laboratory in a hospital from June to December 2019 were retrospectively collected.According to the clinical outcome of the patients,they were divided into ICU and non-ICU groups.The differences in clinical manifestations and laboratory indicators between the two groups were analyzed.The receiver operating characteristic curve(ROC)was used to screen the more valuable predictive indicators.Results Compared with the non-ICU group,ICU group SFTS patients had significantly higher procalcitonin(PCT),C-reactive protein(CRP),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),glutamyl transpeptidase(GGT),leucine aminopeptidase(LAP),glutamate dehydrogenase(GDH),adenosine deaminase(ADA),cystatin C(Cys C),α-hydroxybutyrate dehydrogenase(α-HBDH),creatine kinase(CK),lactate dehydrogenase(LDH)levels(W=530.0,P=0.003;W=496.5,P=0.015;W=496.0,P=0.015;W=535.5,P=0.002;W=545.5,P=0.001;W=498.5,P=0.013;W=537.0,P=0.002;W=523.0,P=0.004;W=512.0,P=0.007;W=502.0,P=0.012;W=486.0,P=0.023;W=509.0,P=0.008;W=541.0,P=0.002)and significantly lower platelet count(PLT),indirect bilirubin(IBIL),albumin/globulin ratio(A/G)and superoxide dismutase(SOD)levels(W=199.0,P=0.024;W=175.5.5,P=0.009;t=-2.9,P=0.004;W=209.5,P=0.036;t=-3.0,P=0.004).ROC result showed that ALP[area under the curve(AUC)=0.804,95%confidence interval(CI)(0.679~0.929)]and LDH[AUC=0.805,95%CI(0.680~0.930)]have a higher value for predicting the risk of severe illness.Conclusions Abnormal liver function,heart function,and renal function indicators in SFTS patients indicate that patients are at risk of exacerbation.Among them,ALP and LDH levels have higher predictive value for risk of severe disease,suggesting that the monitoring of patients with the above symptoms should be strengthened in the clinical nursing process.