肾综合征出血热患者2245例的临床流行病学特征及预后危险因素分析

Clinical epidemiological characteristics and prognostic risk factors in 2245 patients with hemorrhagic fever with renal syndrome

目的:分析肾综合征出血热(HFRS)的临床流行病学特征及影响预后的危险因素。方法:纳入2008年9月至2021年12月空军军医大学第二附属医院收治的2245例HFRS患者,分析HFRS患者的临床流行病学资料,包括性别、年龄、发病季节、发病地区、病死率等,分析2008年至2012年、2013年至2017年和2018年至2021年组HFRS患者的临床流行病学特征。统计学分析采用χ^(2)检验,组间两两比较采用Bonferroni调整P值法,logistic回归分析筛选评估影响预后的危险因素。结果:2245例HFRS患者的年龄为(42.3±15.9)岁,以男性[79.24%(1779/2245)]为主,发病地区以西安市[69.53%(1561/2245)]为主,死亡132例,总病死率为5.88%。2008年至2012年有1088例(48.46%)患者,病死率为7.17%(78/1088);2013年至2017年有647例(28.82%)患者,病死率为5.10%(33/647);2018年至2021年有510例(22.72%)患者,病死率为4.12%(21/510),2008年至2021年HFRS病例数和病死率均呈波动下降趋势。不同年份组患者的病死率、年龄分布、发病季节、发病地区差异均有统计学意义(χ^(2)=6.84、49.22、83.47、19.29,均P<0.05)。进一步两两比较,2018年至2021年组年龄>60岁患者比例[23.33%(119/510)]分别高于2008年至2012年组的12.13%(132/1088)和2013年至2017年组的12.36%(80/647),差异均有统计学意义(均P<0.05);2018年至2021年组大高峰期(10月至12月)发病患者比例为62.35%(318/510),2013年至2017年组为56.26%(364/647),均低于2008年至2012年组的75.18%(818/1088),差异均有统计学意义(均P<0.05);年龄>60岁患者的病死率为9.67%(32/331),分别高于年龄<30岁患者的2.86%(16/559)和30~60岁患者的6.20%(84/1355),差异均有统计学意义(均P<0.05)。单因素分析显示,年龄为30~60岁、年龄>60岁、吸烟、有高血压病史、低血压休克和低氧血症与HFRS患者预后具有相关性[比值比(OR)=2.243、3.632、1.484、3.532、79.422、143.955,均P<0.05],多因素logistic回归分析发现有高血压病史(OR=2.467,P=0.004)、低血压休克(OR=11.658,P=0.001)和低氧血症(OR=67.767,P<0.001)是影响HFRS患者预后的独立危险因素。结论:2008年至2021年HFRS流行出现新的变化特征,其发病人数和病死率呈下降趋势,60岁以上的老年HFRS患者比例较前增加。合并高血压、出现低血压休克和发生低氧血症是影响HFRS预后的独立危险因素。

Objective To analyze the clinical epidemiological characteristics and the prognostic risk factors of patients with hemorrhagic fever with renal syndrome(HFRS).Methods A total of 2245 HFRS patients who were admitted to the Second Affiliated Hospital of Air Force Medical University from September 2008 to December 2021 were enrolled.Clinical epidemiological data(including gender,age,onset season,onset region,case fatality rate,et al)of HFRS patients were analyzed.The clinical epidemiological characteristics of patients with HFRS in the 2008 to 2012,2013 to 2017,and 2018 to 2021 groups were compared.Statistical comparisons were performed using chi-square test.The Bonferroni adjusted P-value method was used for pairwise comparisons between groups,and logistic regression analysis was used to screen and evaluate the risk factors associated with the prognosis of HFRS patients.Results The age of 2245 HFRS patients was(42.3±15.9)years old.Most of them were male(79.24%(1779/2245)),and the main incidence area was Xi′an City(69.53%(1561/2245)).There were 132 deaths with an overall case fatality rate of 5.88%.There were 1088 patients(48.46%)from 2008 to 2012,647 patients(28.82%)from 2013 to 2017,and 510 patients(22.72%)from 2018 to 2021,with a mortality rate of 7.17%(78/1088),5.10%(33/647)and 4.12%(21/510),respectively.From 2008 to 2021,both the number of HFRS cases and the case fatality rate had shown a fluctuating downward trend.There were significant differences in case fatality rate,age distribution,onset season,and onset region among patients in the different year groups(χ^(2)=6.84,49.22,83.47 and 19.29,respectively,all P<0.05).The results of pairwise comparisons showed that the proportion of patients aged>60 years in the 2018 to 2021 group(23.33%(119/510))was higher than those in the 2008 to 2012 group(12.13%(132/1088))and the 2013 to 2017 group(12.36%(80/647)),and the differences were statistically significant(both P<0.05).The proportions of patients at large peak(October to December)were 62.35%(318/510)in the 2018 to 2021 group and 56.26%(364/647)in the 2013 to 2017 group,which were both lower than that in the 2008 to 2012 group(75.18%(818/1088)),and the differences were both statistically significant(both P<0.05).The case fatality rate of patients aged>60 years was 9.67%(32/331),which was higher than those of patients aged<30 years(2.86%(16/559))and patients aged 30 to 60 years(6.20%(84/1355)),with statistically significant differences(both P<0.05).Univariate analysis showed that age 30 to 60 years,age>60 years,smoking,complicated with hypertension,hypotensive shock and hypoxemia were significantly correlated with the prognosis of HFRS patients(odds ratio(OR)=2.243,3.632,1.484,3.532,79.422 and 143.955,respectively,all P<0.05).The results of multivariate logistic regression analysis indicated that complicated with hypertension(OR=2.467,P=0.004),hypotensive shock(OR=11.658,P=0.001),and hypoxemia(OR=67.767,P<0.001)were the independent risk factors affecting the prognosis of HFRS patients.Conclusions The prevalence of HFRS has shown new changing characteristics from 2008 to 2021.The numbers of HFRS patients and the case fatality rates show a downward trend,and the proportion of HFRS patients aged>60 years increases.Complicated with hypertension,hypotensive shock and development with hypoxemia are the independent risk factors for the prognosis of HFRS.