新型布尼亚病毒感染致发热伴血小板减少综合征临床特点及预后影响指标

摘要

目的:探讨新型布尼亚病毒感染致发热伴血小板减少综合征(SFTS)的临床特点及对影响预后的指标进行分析.方法:选取医院收治的42例新型布尼亚病毒感染致SFTS患者,回顾性分析患者的临床特点,根据患者的生存与否分为生存组(40例)和死亡组(2例),对两组影响预后的血常规、肝功能及凝血功能等指标进行对比分析,包括血常规、肝功能、凝血功能等.结果:两组患者均为散发病例,农民居多,41例(占97.62%),6~9月份为发病高峰期.所有患者均有发热,主要症状为纳差、乏力、全身酸痛等,主要体征为淋巴结肿痛,肢体震颤,皮下出血.42例治疗前血小板计数、白细胞计数均有不同程度降低,谷草转氨酶、丙氨酸转氨酶、肌酸激酶均有升高.其中21例淀粉酶升高,6例肾功能损害.治疗后42例患者与治疗前比较白细胞、血小板计数均明显升高,差异有统计学意义(t=20.401,t=12.979;P<0.001);其中存活40例,死亡2例.死亡组患者的谷草转氨酶、丙氨酸转氨酶、肌酸激酶、凝血酶原时间、活化部分凝血活酶时间、凝血酶时间均明显高于生存组患者,血小板计数明显低于生存组患者,两组比较有统计学意义(t=5.281,P<0.001).结论:新型布尼亚病毒感染致SFTS临床症状及体征多样,并常伴实验室指标异常;血小板显著下降、凝血功能及肌酶明显升高是导致SFTS患者死亡的重要影响因素.%Objective:To investigate clinical characteristics of severe fever with thrombocytopenia syndrome (SFTS) infected by new Bunia virus and analyze the indicators which would affect prognosis.Methods: 42 patients with SFTS infected by new Bunia virus were enrolled and their clinical characteristics were analyzed by this retrospective study. 42 cases were divided into the survival group (40 cases) and the death group (2 cases) according to the survival situation. The series indicator, such as blood routine, liver function and coagulation function, were compared and analyzed between the two group.Results: The 42 cases were sporadic, the main of them were farmers, who were 41 cases (accounting for 97.62%). And the peak period of occurrence of this disease was from June to September. Before the treatment, the values of platelet count and the white blood count were decrease in different degrees among all the patients, while glutamic oxalacetic transaminase, alanine transaminase and creatine kinase were increase to some extent. Among them, 21 cases were with higher amylase, and 6 cases were with renal function damage. After the treatment, the values of white blood count and the platelet count of the 42 patients were significantly higher than those before the treatment (WBC:t=20.401,P<0.001, PLT:t=12.979,P<0.001). The glutamic oxalacetic transaminase, alanine aminotransferase, creatine kinase, prothrombin time, activated partial thromboplastin time and thrombin time of the death group were significantly higher than those of the survival group, and the value of platelet count of death group was significantly lower than that of survival group (t=5.281,P<0.001). 42 cases were sporadic, the majority of which were farmers, accounting for 97.62% (41/42). And June to September is the peak period. All the patients had fever, and the main symptoms were anorexia, fatigue, aching, and the main signs were lymph node swelling, tongue body and limb tremor. 42 cases of platelet count (PLT), the white blood count (WBC) reduced to some extent, aspartate transaminase (AST), alanine transaminase (ALT), creatine kinase (CK) were increased. among them 21 cases of higher amylase, 6 cases of renal damage. After the treatment, the WBC and PLT of 42 patients were significantly higher than before treatment (WBC:t=20.401,P<0.001, PLT:t=12.979,P<0.001), among them 40 cases were cured, but 2 cases died. ALT, AST, CK, prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of patients in the death group were significantly higher than the survival group, and PLT was significantly lower than that of the survival group (t=5.281,P<0.001).Conclusion: SFTS caused by new Bunia virus has diverse clinical symptoms and signs, and it is often accompanied with abnormal laboratory indicators. Besides, the significant decrease of PLT, and the obvious increases of coagulation function and creatine kinase were the important influencing factors for the death of SFTS patients.