发热伴血小板减少综合征人人间传播患者临床特征分析

摘要

Background In recent years,more and more reports have focused on person - to - person transmission of severe fever with thrombocytopenia syndrome( SFTS),however,there is still lack of a detailed summary. Objective To summarize the risk factors,clinical manifestations and results of laboratory testing of patients with person - to - person transmission of SFTS for improving the clinical understanding person - to - person transmission of SFTS,and reducing the person- to - person transmission,misdiagnosis and mistreatment of the disease. Methods We retrieved Medline,PubMed,Embase, Google Scholar Databases,www. cnki. net,WANFANG DATA,VIP from January 2007 to March 2016,using advanced search, with“发热伴血小板减少综合征”“人人间传播”" severe fever with thrombocytopenia syndrome" and " person - to - person transmission" . We downloaded and read the full text of all the documents,excluded the articles which were repeatedly collected, published or reported by the same unit or person. And we analyzed the clinical data of the included 56 patients with person - to -person transmission of SFTS retrospectively. Results From the included 7 articles,a total of 56 patients were retrieved, including 8 index patients and 48 secondary patients. The incubation of secondary patients with person - to - person transmission of SFTS was 6 to 15 days. Forty - five patients infected with SFTS due to blood or bloody discharge contact,2 due to suspected droplet contact,and 1 due to tick bite. The main clinical manifestations were fever,chills,diarrhea,followed by nausea, vomiting,bleeding,abdominal pain,cough,rash,conjunctival congestion,headache,myalgia and so on. All patients had declined in leucocyte and platelet count,elevated alanine aminotransferase and serum aspartate aminotransferase. Other abnormal results of laboratory testing included elevated lactic dehydrogenase,activated partial thromboplastin time prolongation and serum creatinine,creatine kinase,proteinuria and haematuria. Conclusion Person - to - person transmission of SFTS has been confirmed. The main risk factors of this kind of disease are blood or bloody discharge contact,and suspected droplet contact. Most SFTS transmissions from person to person are overt infection and few are covert infection. Compared with the index patients, secondary patients infected by tick bite have shorter incubation,mild clinical sympotoms,lower mortality and better prognosis if they are treated early.%背景发热伴血小板减少综合征（SFTS）人人间传播的患者报道越来越多，但缺乏详尽的临床特征总结。目的总结我国 SFTS 人人间传播患者的危险因素、临床表现、实验室检查特点，提高临床医生对 SFTS 人人间传播的认识，减少 SFTS 人人间传播及误诊误治。方法检索2007年1月—2016年3月 Medline、PubMed、Embase、Google Scholar Databases、中国期刊全文数据库、万方全文数据库、维普全文数据库，采用高级检索，检索项均为全部字段，以“发热伴血小板减少综合征”“人人间传播”“severe fever with thrombocytopenia syndrome”和“person - to -person transmission”为检索词，下载检索到的全部文献，仔细阅读所有文献的全文，剔除重复收录、重复发表、同一单位或个人的重复报道的文献。回顾性分析符合纳入标准的56例 SFTS 人人间传播患者的临床资料。结果检索到符合标准的文献7篇，共56例患者，其中原发患者8例，继发患者48例。继发患者潜伏期为6~15 d；45例有接触原发患者血液或血性分泌物的危险因素，2例可疑经空气传播，1例经蜱虫传播；主要临床表现为发热、寒战、腹泻，其次为恶心、呕吐、出血、腹痛、咳嗽、皮疹、结膜充血、头痛、肌痛等。患者均出现白细胞计数及血小板计数下降，血清丙氨酸氨基转移酶及血清天冬氨酸氨基转移酶升高；其余实验室检查结果异常包括乳酸脱氢酶升高、活化部分凝血活酶时间延长、肌酐升高、肌酸激酶升高、出现蛋白尿及血尿。结论 SFTS 人人间传播得到证实，主要通过接触患者血液或血性分泌物传播，有可疑空气传播。大部分为显性感染，少部分为隐性感染。人人间传播的潜伏期比蜱虫叮咬传播的潜伏期短，临床症状轻，病死率低，早期诊治预后良好。