山东省发热伴血小板减少综合征实验室确诊病例临床与流行特征分析

摘要

目的 了解山东省发热伴血小板减少综合征(SFTS)实验室确诊病例的临床和流行特征.方法 以山东省2013年网络报告的SFTS实验室确诊病例为调查对象,通过现场问卷调查方法收集病例的相关信息,运用epidata3.1、SPSS17.0、ArcGIS9.3等软件进行数据整理和分析.结果 山东省SFTS病死率为7.1％,病例发病时间集中在5-10月份,鲁中和鲁东山区丘陵地区是病例的高发区,高危人群主要为40岁以上中老年人(97.4％),职业特征主要为农民(93.5％).85.7％病例居住在山区或丘陵地带,83.8％病人发病前两周有户外活动史,16.8％的病人有明确蜱叮咬史,羊、牛、狗、猫的带蜱率高,分别为66.7％、40.0％、34.3％、12.5％,直接接触死亡病例血液及血性分泌物可感染该病.临床表现主要为发热(98.1％)、食欲减退(90.9％)、乏力(81.2％)、恶心(53.3％)、白细胞降低(60.4％)、血小板减少(73.4％).35.7％的病例治疗需经过3次以上的转诊,发病到确诊的中位天数为5d,极值(3～15)d,能够做出正确诊断的医院均为县级以上医院.与康复病例比较死亡病例多为高年龄组人群(t=2.03,P=0.044),伴有出血表现(x2=13.09,P＜0.01),组间差异有统计学意义.结论 SFTS是一种病死率较高的疾病,生产生活在丘陵山区的环境、从事农业劳动、饲养动物及其带蜱率以及直接接触死亡病例血液可能为发病的危险因素.目前基层对该病的诊断能力较低,应加强防治知识宣传和医务人员诊疗技能培训,减少该病的发病和死亡.%We investigated the clinical and epidemiological characteristics of laboratory confirmed cases of severe fever with thrombocytopenia syndrome (SFTS) in Shandong Province,China.A descriptive epidemiological method combined with case investigation was used in this study.Cases information were collected by standard questionnaire and analyzed by Epidata3.1,SPSS 17.0 and ArcGIS10.0 software.Results showed that a total of 154 cases were analyzed and the case fatality rate was 7.1％.Epidemic peak was from May to October,the high incidence areas were located in the middle and east hilly areas of Shandong Province.The characteristic of SFTS cases were farmers (93.5％),and the age was over 40 years.Most of them were living in the hilly areas (85.7 ％),and had outdoor activities within the previous 2 weeks prior to fever onset (83.8 ％).The 16.8％ of them had tick bites history.Tick carrying rates of sheep,cattle,dogs and cats were 66.7％,40％,34.3％ and 12.5％,respectively.Directly contact with bloody secretion of SFTS death cases can be infected with the disease.Major symptoms include high fever (98.1％),anorexia (90.9 ％),fatigue (53.3％),thrombocytopenia (73.4 ％) and leukocytopenia (60.4 ％).The 35.7 ％ cases need to go through more than three referrals for treatment,the interval time between onset and diagnosis was 5 days(3-15),only hospitals above county level can make the correct diagnosis of the disease.Compared with survival patients,the death cases were elderly patients (t =2.03,P=0.044) and with bleeding performance (x2 =13.09,P＜0.01).In conclusion,SFTS is a severe disease with high mortality.Living hilly environment,doing agricultural labor,feeding animals,tick carrying rates of animals and direct contacting with bloody secretion of deaths maybe possible risk factors.To reduce morbidity and mortality of SFTS,measures should be carried out to propagandize the basic knowledge for SFTS prevention and control and to improve the medical treatment skills of doctors in the epidemic foci.