发热伴血小板减少综合征与肾综合征出血热的临床特征分析

Analysis of clinical characteristics in severe fever with thrombocytopenia syndrome and hemorrhagic fever with renal syndrome

目的通过比较发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)和肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者在流行病学、临床表现和实验室指标等方面的参数差异,提高对2种疾病的临床认识,减少误诊率。方法回顾性分析2021年1月至2023年12月期间,烟台市奇山医院和青岛市第六人民医院收治的219例SFTS患者(SFTS组)和201例HFRS患者(HFRS组)的病历资料,使用独立样本t检验、方差分析、χ^(2)检验等比较2组间流行病学、临床表现、实验室指标等参数的差异,建立鉴别诊断的随机森林模型。结果SFTS与HFRS患者存在差异的参数有年龄、性别、发病季节、接触史、预后、病情程度;结膜出血、皮肤瘀点瘀斑、腰痛、眼眶痛、少尿、神经系统症状、肾区叩击痛等临床表现;白细胞计数、凝血酶原时间、天冬氨酸转氨酶、肌酐、尿素氮、肌酸激酶、蛋白尿等化验指标。随机森林模型筛选出重要性排名前5位的参数为白细胞计数分层、C-反应蛋白、疾病分型、肌酐、粘膜出血。结论本研究中SFTS患者较HFRS患者更易出现心肌、肝脏、中枢神经系统损伤,而HFRS患者较SFTS患者更易表现肾脏损伤,从而呈现相应症状和实验室指标的差异。

Objective To compare the differences in epidemiological,clinical,and laboratory parameters between patients with Severe Fever with Thrombocytopenia Syndrome(SFTS)and Hemorrhagic Fever with Renal Syndrome(HFRS),which may improve clinical knowledge of both diseases and reduce misdiagnoses.Methods Two hundred and nineteen patients with SFTS(SFTS group)and 201 patients with HFRS(HFRS group)admitted to Yantai Qishan Hospital and Qingdao No.6 People’s Hospital from January 2021 to December 2023 were retrospectively analyzed.Independent samples t-tests,analysis of variance(ANOVA),and chi-square tests were used to compare differences in the epidemiological parameters,clinical manifestations and laboratory indicators between the 2 groups.A random forest model to distinguish the two diseases was established.Results Epidemiological parameters that differed between SFTS and HFRS patients were age,sex,season of onset,exposure history,prognosis,and degree of disease;clinical manifestations that differed between SFTS and HFRS patients were conjunctival hemorrhage,skin petechiae and ecchymosis,lumbar pain,orbital pain,oliguria,neurological symptoms,and renal regional percussion pain;laboratory parameters that differed between SFTS and HFRS patients were white blood cell count,prothrombin time,aspartate transaminase,creatinine,blood urea nitrogen,creatine kinase,and proteinuria.The top 5 parameters screened by the random forest model were white blood cell count stratification,C-reactive protein,disease typing,creatinine,and mucosal hemorrhage.Conclusions Patients with SFTS were more prone to myocardial,liver,and central nervous system damage compared to HFRS patients.HFRS patient were more likely to exhibit renal damage.