老年脓毒症相关性噬血细胞综合征的临床特征分析

Analysis of clinical features of sepsis-associated hemophagocytic lymphohistiocytosis in the elderly

目的分析老年脓毒症相关性噬血细胞性淋巴组织细胞增生症(HLH)病人的临床特征、实验室检查特点及转归,旨在早期发现,降低病死率。方法回顾性收集2013年6月至2022年3月南京市第一医院年龄≥65岁的32例老年脓毒症相关性HLH病人(老年组)的临床信息,并与同期收治的24例非老年脓毒症相关性HLH病人(非老年组)做比较,分析2组临床特点和病死率。结果与非老年组相比,老年组伴有高血压、脑血管疾病的比例更高,病人生存时间更短,差异均有统计学意义(P<0.05)。老年组28 d及90 d死亡率均高于非老年组(62.5%比25.0%,81.3%比45.8%,P均<0.05),BUN、血肌酐(SCr)、胱抑素C(CysC)及肌钙蛋白(TnT)水平高于非老年组(P<0.05);非老年组肝脾肿大发生率明显高于老年组(66.7%比25.0%,P<0.05);2组应用含激素的治疗方案的病死率差异无统计学意义(P>0.05)。结论老年脓毒症相关性HLH病死率更高,易并发心、肾功能损害,早发现、早治疗对降低病人病死率至关重要。

Objective To analyze the clinical characteristics,laboratory test characteristics and prognosis of the elderly patients with sepsis-related hemophagocyic lymphohistiocytosis(HLH),and to provide evidence for early detection and reduction of mortality.Methods The clinical information of 32 elderly patients with sepsis-related HLH(aged group)and 24 non-elderly patients with sepsis-related HLH(non-aged group)from June 2013 to March 2022 in Nanjing First Hospital were retrospectively collected.The clinical characteristics and mortality of the two groups were analyzed and compared.Results The proportion of the patients with hypertension and cerebrovascular diseases was significantly higher and the survival time was shorter in the aged group than that in the non-aged group.The 28-day mortality rate and 90-day mortality rate in the aged group were higher than those in the non-aged group(62.5%vs 25.0%,81.3%vs 45.8%,P<0.05),and there were significant differences in the levels of blood urine nitrogen(BUN),serum creatinine(SCr),Cystatin C(CysC)and Troponin T(TnT)between the two groups(P<0.05).The aged group had a higher incidence rate of hepatosplenomegaly compared with the non-aged group(66.7%vs 25.0%,P<0.05).There was no significant difference in mortality due to different treatment regimens containing hormones between the two groups(P>0.05).Conclusions Sepsis-related HLH in the elderly patients has a higher mortality rate and is prone to causing heart and renal damage.Early detection and early treatment are crucial to reduce the mortality rate of the patients.