2014年浙江省发热伴血小板减少综合征流行特征分析北大核心CSCD

目的分析浙江省2014年发热伴血小板减少综合征(SFTS)流行病学特征。方法收集2014年浙江省SFTS病例资料,建立数据库并分析。结果 2014年浙江省SFTS确诊病例57例,死亡10例,病死率为17.54%。病例呈现出5月和8月两个高峰期;平均年龄为(58.75±16.30)岁,不同年龄组人群病死率不同(χ2=10.148,P=0.008,P=0.05);农民占89.29%。病例发病前2周内53.85%的病例有户外活动史,多从事种地、割草、采茶等活动,29.09%有明确蜱暴露史,54.90%家里饲养动物,51.06%有老鼠暴露史。大部分病例有发热、疲劳、畏寒、肌痛等非特异性症状,且均伴有血小板和白细胞进行性下降;存活和死亡病例间牙龈出血症状不同(χ2=4.114,P=0.043,P=0.05)。存活组从发病到确诊时间间隔平均5.5d,死亡组7.5d,病例从确诊到死亡平均3.5d,其中有2人是死亡后才被确诊。结论浙江省发热伴血小板减少综合征发病具有一定的地域性和季节性,中老年农民高发,户外活动做好个人防护及早诊断、早治疗对该病的预防控制有重要意义。     

2014年浙江省发热伴血小板减少综合征流行特征分析

目的分析浙江省2014年发热伴血小板减少综合征(SFTS)流行病学特征。方法收集2014年浙江省SFTS病例资料,建立数据库并分析。结果2014年浙江省SFTS确诊病例57例,死亡10例,病死率为17.54%。病例呈现出5月和8月两个高峰期;平均年龄为(58.75±16.30)岁,不同年龄组人群病死率不同(χ²=10.148,P=0.008,P=0.05);农民占89.29%。病例发病前2周内53.85%的病例有户外活动史,多从事种地、割草、采茶等活动,29.09%有明确蜱暴露史,54.90%家里饲养动物,51.06%有老鼠暴露史。大部分病例有发热、疲劳、畏寒、肌痛等非特异性症状,且均伴有血小板和白细胞进行性下降;存活和死亡病例间牙龈出血症状不同(χ²=4.114,P=0.043,P=0.05)。存活组从发病到确诊时间间隔平均5.5 d,死亡组7.5 d,病例从确诊到死亡平均3.5 d,其中有2人是死亡后才被确诊。结论浙江省发热伴血小板减少综合征发病具有一定的地域性和季节性,中老年农民高发,户外活动做好个人防护及早诊断、早治疗对该病的预防控制有重要意义。     

动态监测动脉血乳酸水平与急性重症颅脑损伤合并脑心综合征预后的关系

目的:分析急性重症颅脑损伤合并脑心综合征(BHS)患者,动脉血乳酸(LAC)水平与预后的关系。方法:选取存活时间超过72 h的重症颅脑损伤患者62例。按照第14天是否存活分为存活组和死亡组,存活组37例,死亡组25例。分析62例患者入院即刻、入院后6、24、48、72 h动脉血LAC水平的动态变化。按动脉血LAC水平将患者分为2组:≥10%为高乳酸水平组,10%为低水平乳酸组,比较2组之间的病死率、APACEHⅡ评分、ICU住院时间和总住院时间。结果:与存活组比较,死亡组治疗前的血气分析指标降低(P0.05);治疗后,存活组的动脉血LAC水平降低,而死亡组不断升高(P0.05)。动脉血LAC水平越高,病死率增加,ICU住院时间明显延长(P0.05)。结论:动脉血LAC水平对评估急性重症颅脑损伤合并脑心综合征的预后有益,及时干预治疗可提高临床生存率及改善预后。     

生命体征及综合评分在预测热射病患者预后中的价值分析

目的探讨热射病患者入院时生命体征及综合评分在预测临床预后中的价值。 方法收集西部战区总医院2012年1月至2018年12月收治入院的34例热射病患者临床资料,根据预后情况分为存活组与死亡组,回顾性分析两组患者临床资料,评价患者入院时生命体征及综合评分在判断该病预后中的临床价值。 结果34例患者中,29例患者好转出院,5例患者死亡,死亡率为14.71%(5/34),死亡组及存活组中多器官功能障碍综合征(MODS)发生率依次为100%及55.17%(16/29);死亡组患者平均年龄、入院时呼吸频率、心率及APACHE Ⅱ评分均高于存活组(P<0.05),GCS评分低于存活组(P＝0.014);死亡组患者总住院时间及ICU时间长于存活组(P<0.05),且呼吸衰竭和酸碱平衡紊乱发生率及呼吸机使用率均高于存活组(P< 0.05),但两组患者入院时体温及平均动脉压差异无统计学意义(P>0.05)。此外,入院时心率、APACHE Ⅱ评分及GCS评分在预测热射病患者死亡中的ROC曲线下面积均大于0.9,入院时呼吸频率、体温及平均动脉压在ROC曲线下面积依次为0.735、0.797及0.614。 结论热射病患者入院时心率、APACHEⅡ评分及GCS评分在预测临床预后中具有较高诊断价值,呼吸频率、体温在预测临床预后中具有中等诊断价值。     

胱抑素C和高敏C反应蛋白与前白蛋白比值评估老年心律失常型心力衰竭预后的价值

目的探讨血清胱抑素C、高敏C反应蛋白(hs-CRP)/前白蛋白比值联合检测评估老年心律失常型心力衰竭(心衰)患者预后的价值。方法选择老年心律失常型心衰患者132例,根据治疗后随访1年生存情况分为存活组114例和死亡组18例,记录一般临床资料,检测N末端B型钠尿肽前体(NT-proBNP)和B型钠尿肽(BNP)水平,比较2组胱抑素C、hs-CRP/前白蛋白比值,采用ROC曲线分析。结果死亡组年龄、收缩压、BNP及NT-proBNP水平明显高于存活组(P<0.05,P<0.01),LVEF明显低于存活组[(40.25±7.14)%vs(47.54±8.21)%,P<0.01]。胱抑素C和hs-CRP/前白蛋白比值与老年心律失常型心衰患者LVEF、NT-proBNP和BNP水平呈正相关(P<0.05,P<0.01)。LVEF、BNP、NT-proBNP、hs-CRP/前白蛋白比值、胱抑素C是死亡危险因素(P<0.05,P<0.01)。胱抑素C联合hs-CRP/前白蛋白比值预测老年心律失常型心衰短期心功能转归及病死率的曲线下面积明显高于胱抑素C、hs-CRP/前白蛋白比值(P<0.05)。结论胱抑素C、hs-CRP/前白蛋白比值是预测老年心律失常型心衰患者预后的敏感指标,三者联合检测可进一步提高短期预后的预测能力。     

动态MELD评分有助于预测HBV相关慢加急性肝衰竭预后

目的探讨在判断HBV相关慢加急性肝衰竭(HBV-related acute-on-chronic liver failure,HBV-ACLF)患者预后方面,终末期肝病模型(model for end-stage liver disease,MELD)评分的动态变化是否优于基线MELD评分。方法前瞻性收集2009—2011年在我国4家医院住院治疗的HBV-ACLF患者的临床资料,包括临床表现、实验室检查及转归等,研究MELD评分动态变化与转归的关系。结果①纳入的82例90 d病死率为37.80%。死亡组患者基线MELD评分为(25.50±4.77)分,与存活组[(23.72±4.68)分]相比,差异无统计学意义(P=0.101)。但是从入组第7天开始,死亡组MELD评分逐渐升高,存活组MELD评分逐渐下降,此后各时间点2组MELD评分相比差异均有统计学意义。②低危组(基线MELD评分≤23分者)从第14天开始,存活患者MELD评分显著低于死亡患者[(16.04±4.00)分vs(29.39±12.30)分,P<0.05],高危组(基线MELD评分>23分者)从第7天开始,存活患者MELD评分显著低于死亡患者[(22.38±4.91)分vs(28.92±6.76)分,P=0.001],并且随着时间推移,差距逐渐增加。结论判断HBV-ACLF的预后应在基线MELD评分基础上,注意其动态变化,这将有助于提高预测的准确性。     

发热伴血小板减少综合征危重度评分对患者预后的评价

目的：探讨发热伴血小板减少综合征（SFTS）死亡相关因素,设立 SFTS 危重度评分并检验其对 SFTS 患者预后的评价作用。方法对2011年6月至2014年10月山东大学附属济南市传染病医院住院治疗并确诊为 SFTS 的123例患者行死亡相关危险因素的 Logistic 回归分析,进而设定 SFTS危重度评分,并通过受试者工作特征曲线（ROC）与快速急诊内科评分（REMS 评分）、急性生理和慢性健康评分系统Ⅱ（APACHEⅡ）进行预后预测能力的比较。结果123例患者中死亡31例（死亡组）,男17例,女14例;生存92例（生存组）,男45例,女47例。单因素 Logistic 回归分析结果显示,格拉斯哥昏迷（GCS）评分、乳酸脱氢酶、部分活化凝血活酶时间、脉搏血氧饱和度与 SFTS 死亡相关,差异均有统计学意义（均 P ＜0．05）。且4项指标的单项评分,死亡组均高于存活组（均 P ＜0．05）。SFTS 死亡组的REMS、APACHEⅡ评分和 SFTS 危重度评分均高于存活组（均 P ＜0．01）。REMS、APACHEⅡ评分和SFTS 危重度评分的曲线下面积（AUC）分别为0．734、0．746、0．788。Youden 指数以 SFTS 危重度评分为最高,当取阈值为15．0时,其预测 SFTS 患者住院期间死亡风险的敏感度为74．2％,特异度为76．1％。结论 REMS、APACHEⅡ评分和 SFTS 危重度评分对 SFTS 预后均具有良好的评价作用,其中以 SFTS 危重度评分更为简捷且预测能力最佳。     

老年重症心力衰竭患者血清NT-proBNP水平及预后危险因素

目的探讨老年重症心力衰竭患者血清氨基末端脑钠尿肽(NT-proBNP)水平及预后危险因素。方法老年重症心力衰竭患者101例(观察组),同时选取健康体检者100例作为对照组,检测血清NT-proBNP水平。比较观察组死亡和存活患者临床资料差异。结果观察组血清NT-proBNP水平明显高于对照组(P0.05);观察组死亡患者血清NT-proBNP水平、美国纽约心脏病学会(NYHA)分级Ⅳ级比例明显高于存活患者,而左室射血分数(LEVF)明显低于存活患者(均P0.05);Logistic回归分析结果显示,血清NT-proBNP、LVEF和NYHA分级是老年重症心力衰竭患者死亡的危险因素(P0.001)。结论老年重症心力衰竭患者血清NT-proBNP水平升高,是影响患者预后的独立危险因素。     

感染性休克患者预后与早期血乳酸清除率的关系

目的:探讨感染性休克患者早期血乳酸清除率与预后的关系。方法:回顾性分析重症监护病房感染性休克患者56例的APACHEⅡ评分、入ICU 6 h后动脉血乳酸清除率及预后。分别将患者分成存活组(33例)和死亡组(23例),高乳酸清除率组(6 h乳酸清除率≥10%)和低乳酸清除率组(6 h乳酸清除率10%),比较各组间的差异。结果:各组年龄、性别、APACHEⅡ评分和基础血乳酸值差异无统计学意义。存活组乳酸清除率明显高于死亡组[(29.8±15.0)%vs(9.7±8.6)%,P0.05];高乳酸清除率组病死率均明显低于低乳酸清除率组(11.5%vs44.0%,P0.01)。结论:早期乳酸清除率≥10%能准确评估感染性休克患者的预后。     

白细胞介素-11与脓毒症心肌损伤预后的关系

摘要：目的 探讨白细胞介素（IL）-11与脓毒症心肌损伤预后的关系。方法 选择2017年1月至2018年6月我院重症医学科收治的44例脓毒症心肌损伤患者,根据患者的预后情况分为存活组（28例）和死亡组（16例）。收集各组患者的临床资料,并检测血IL-11水平。通过脉搏指示连续心排血量监测(PiCCO)监测患者的血流动力学。结果 与存活组相比,死亡组患者心脏指数(CI)、心功能指数(CFI)、全心射血分数(GEF)和左心室收缩力指数(dP/dPmax)等指标显著降低,差异有统计学意义（P<0.05）;与存活组相比,死亡组患者SOFA评分和IL-11水平显著升高,差异有统计学意义（P<0.05）;ROC曲线分析结果表明,血清IL-11对脓毒症心肌损伤患者预后具有一定的预测价值（P<0.05）,其AUC、敏感度和特异度分别为0.883、73.7%和80.5%。结论 血IL-11水平有助于预测脓毒症心肌损伤患者的预后。     

发热伴血小板减少综合征死亡病例的流行病学和临床特征分析

目的 探讨发热伴血小板减少综合征（SFTS）死亡病例的流行病学和临床特征.方法 应用病例-对照研究方法,分别对16例SFTS死亡病例（病例组）和16例一般病例（对照组）的临床与流行病学信息进行统计分析,本研究所有病例均为发热伴血小板减少综合征实验室确诊病例.结果 病例组和对照组有蜱叮咬史的比例分别为25.00％和18.75％,有田间劳作史的比例分别为75.00％和81.25％,差异均无统计学意义（P值均＞0.05）.死亡病例发病至死亡平均时间为10天,发病至确诊平均时间为4天.病例组从发病到首诊的时间间隔和住院治疗天数均显著小于对照组,差异有统计学意义（P值均＜0.05）.62.50％的死亡病例伴有基础疾病,显著高于对照组25％的比例,差异有统计学意义（P=0.035）.病例组具有神经系统症状的比例（87.50％）显著高于对照组（37.50％）,差异有统计学意义（P＜0.05）.病例组ALT、AST、LDH、CK和BUN均高于对照组,但两组比较差异均无统计学意义.结论 既往有基础疾病史和有神经系统症状的患者,死亡风险较高.     

人感染新型布尼亚病毒病临床和流行病学特征分析

【摘要】目的：分析人感染新型布尼亚病毒病的临床特点和流行病学特征,为制定预防控制措施提供依据。方法：采用统一的诊断标准和流行病学个案调查表对病例进行调查。结果：33例疑似病例中有20例确诊人感染新型布尼亚病毒病,病死率为30%。临床表现主要为发热（100%）、乏力（80%）、畏寒和呕吐（60%）;血常规检查有血小板计数减少（100%）和白细胞计数减少（90%）;病例多来自丘陵地区,以男性、中老年、农民为主,发病时间呈两个高峰,分别为6～7月和9～10月,部分病例发病前有明确的蜱叮咬史。结论：SFTS病例发病初期临床症状不典型,发病有地域特征,散发病例多见,但不排除人与人传播的可能。     

Clinical progress and risk factors for death in severe Fever with thrombocytopenia syndrome patients

Background.?Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the SFTS virus (SFTSV) with an average fatality rate of 12%. The clinical factors for death in SFTS patients remain unclear. Methods.?Clinical features and laboratory parameters were dynamically collected for 11 fatal and 48 non-fatal SFTS cases. Univariate logistic regression was used to evaluate the risk factors associated with death. Results.?Dynamic tracking of laboratory parameters revealed that during the initial fever stage, the viral load was comparable for the patients who survived as well as the ones that died. Then in the second stage when multi-organ dysfunction occurred, from 7-13 days after disease onset, the viral load decreased in survivors but it remained high in the patients that died. The key risk factors that contributed to patient death were elevated serum aspartate aminotransferase, lactate dehydrogenase, creatine kinase, and creatine kinase fraction, as well as the appearance of CNS (central nervous system) symptoms, hemorrhagic manifestation, disseminated intravascular coagulation, and multi-organ failure. All clinical markers reverted to normal in the convalescent stage for SFTS patients who survived. Conclusions.?We identified a period of 7-13 days after the onset of illness as the critical stage in SFTS progression. A sustained serum viral load may indicate that disease conditions will worsen and lead to death.     

Corticosteroids May Have Negative Effects on the Management of Patients with Severe Fever with Thrombocytopenia Syndrome: A Case–Control Study

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral hemorrhagic fever in China, Korea, and Japan. To date, no standardized treatment protocol for SFTS has been established. Corticosteroids (CS) may be administered to patients with SFTS and hemophagocytic syndrome, but its effectiveness and safety are still debatable. We conducted a retrospective case series review at four medical facilities in Miyazaki, Japan. Based on the medical records, clinical data, including the patients background, symptoms, physical findings, laboratory data at initial presentation, treatment, and outcome, were compared between the CS-treated and the non-CS-treated group. A total of 47 patients with confirmed SFTS in each hospital were enrolled in this study; there were 14 fatal cases and 33 nonfatal cases. The case fatality ratio was 29.8%. After adjusting patients’ background by propensity score matching, the case fatality ratio was higher (p = 0.04) and complications of secondary infections, including invasive pulmonary aspergillosis, tended to be more frequent (p = 0.07) in the CS-treated group than in the non-CS-treated group. These data suggested that administration of CS to patients with SFTS should be carefully considered.     

Neurological involvement in acute Q fever: a report of 29 cases and review of the literature

BACKGROUND: Q fever is characterized by its clinical polymorphism; neurological involvement has occasionally been described. In the course of acute Q fever, neurological manifestations may include aseptic meningitis, encephalitis or encephalomyelitis, and peripheral neuropathy. OBJECTIVE: To review and evaluate cases of acute Q fever with neurological symptoms diagnosed in our laboratory. METHODS: A total of 1269 acute Q fever cases were recorded from January 1985 to January 2000 in our laboratory and were reviewed for neurological complications. Patients were considered to have acute Q fever when serological procedures showed Coxiella burnetii phase II titers of 1:200 or higher for IgG and 1:50 or higher for IgM. Those patients who underwent a lumbar puncture for cerebrospinal fluid analysis or who had abnormal neurological symptoms were selected for this study. We describe the clinical, epidemiological, and biological features of these cases. We also review the literature and compare our cases with those previously reported. RESULTS: Among the 45 patients selected, 14 were excluded because they had normal cerebrospinal fluid and no neurological symptoms. Two were excluded because there were no clinical or epidemiological data. Three major clinical syndromes were observed: meningoencephalitis or encephalitis in 17 cases; meningitis in 8; and myelitis and peripheral neuropathy in 4. Encephalitic signs were not specific, but behavior or psychiatric disturbances were common. CONCLUSIONS: Q fever should be included in the differential diagnosis of acute neurological disease in a patient with a fever. Serological testing should be performed in cases of meningoencephalitis, lymphocytic meningitis, and peripheral neuropathy, including Guillain-Barré syndrome and myelitis.     

发热伴血小板减少综合征合并脑部症状患者临床资料分析

目的 分析发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome, SFTS)患者的人口学特征、临床表现和实验室参数变化,为尽早识别合并脑部症状的SFTS患者提供依据。方法 回顾性分析2013年1月至2018年6月安徽省4家医院收治的发热伴血小板减少综合征确诊病例资料。根据是否合并脑部症状分为两组,采用独立样本T-检验、Mann-Whitney检验、卡方检验或Fisher精确概率法比较两组间各项临床指标差异。结果 共收集SFTS病例208例,其中合并脑部症状组 62例,未合并脑部症状组146例。组间比较分析发现,合并脑部症状SFTS患者病死率较高(17.74% vs 5.48%,χ²=7.884,P=0.005)。在整个住院期间,两组12项实验室参数差异有统计学意义(均P<0.05);发热期,合并脑部症状的SFTS患者BUN(Z=2.084,P=0.037)、CREA(Z=-2.698,P=0.007)、UA(Z=-2.289,P=0.022)、CRP(Z=-3.209,P=0.001)、PCT(Z=-2.647,P=0.008)更高,而LYNP(Z=-2.240,P=0.025)、PLT(Z=-2.469,P=0.014)、TP(Z=-2.142,P=0.032)、ALB(t=2.172,P=0.032)、CO₂CP(Z=-2.245,P=0.025)、FDP(Z=-2.829,P=0.002)较低;多器官功能障碍期,合并脑部症状组的GRA(Z=-2.346,P=0.019)、TB(Z=-3.199,P=0.001)、CRP(Z=-2.605,P=0.009)和Ca(Z=-2.807,P=0.005)较高,LYNP(Z=-2.790,P=0.005)、RET(Z=-2.329,P=0.020)和AMY(Z=-2.144,P=0.032)较低;恢复期,合并脑部症状组的CK(Z=-2.007,P=0.045)较高,PLT(Z=-2.856,P=0.004)、AMY(Z=-2.586,P=0.010)较低。结论 合并脑部症状SFTS病死率较高,住院期间,尤其是早期应密切关注BUN、CREA和CO₂CP变化,尽早识别可能的合并脑部症状患者。     

急性Stanford B型主动脉夹层84例临床分析

目的:研究急性Stanford B型主动脉夹层患者的临床特征,寻找影响预后的危险因素.方法:回顾性分析84例急性Stanford B型主动脉夹层患者的临床资料以及住院期间转归,并对数据进行统计学分析.结果:84例急性Stanford B型主动脉夹层患者中,男73例,女11例,平均年龄(52±12.7)岁,发病时间以3、...     

蓬莱市人民医院发热伴血小板减少综合征53例临床分析

目的研究发热伴血小板减少综合征的流行病学和临床特点,以提高对该病的认识。方法对蓬莱市人民医院2011—2013年收治的53例发热伴血小板减少综合征的临床资料进行回顾性分析。结果病例呈高度散发,以农民(94.34%)为主,聚集性发病14例,6—9月为发病高峰。所有患者均发热,主要症状为乏力、全身酸痛、纳差和恶心,主要体征为腹股沟淋巴结肿大和触痛(64.15%)、舌体及肢体震颤(58.49%)。实验室检查结果为发病早期WBC下降(94.34%)、PLT下降(88.68%)和嗜酸性粒细胞比例降低(98.11%),ALT、AST、乳酸脱氢酶、肌酸激酶同工酶和空腹血糖升高以及蛋白尿。治愈39例,死亡14例(26.42%)。年龄偏大、既往有基础疾病、发病后未及时诊治以及有神经系统症状患者病情较重,病死率较高。结论早发现、早诊断、早治疗,同时防止并发症,加强消毒隔离和防护措施,可降低病死率。     

The temporal dynamics of EEG changes in the early phase of herpes simplex encephalitis

In 19 patients with herpes simplex encephalitis 64 EEG examinations and 36 CT scans have been performed within the first two weeks after onset of clinical symptoms. During the first 10 days periodic discharges were present in 12 patients. At this time CT scan was negative in 5 of them. Five of 7 patients without but only 4 of 12 patients with this EEG pattern survived without clinical abnormalities. Five patients with periodic discharges died during the acute stage of the illness. In patients with poor outcome including major clinical deficit or death periodic discharges were present during successive investigations until day 14. In the group of patients with good clinical improvement these EEG changes were only detected in a single recording until day 7. Periodic discharges have to be considered as an indicator of a poor prognosis whenever they are present for a longer period.     

Pathological Characteristics of a Patient with Severe Fever with Thrombocytopenia Syndrome (SFTS) Infected with SFTS Virus through a Sick Cat’s Bite

A woman in her fifties showed symptoms of fever, loss of appetite, vomiting, and general fatigue 2 days after she was bitten by a sick cat, which had later died, in Yamaguchi prefecture, western Japan, in June 2016. She subsequently died of multiorgan failure, and an autopsy was performed to determine the cause of death. However, the etiological pathogens were not quickly identified. The pathological features of the patient were retrospectively re-examined, and the pathology of the regional lymph node at the site of the cat bite was found to show necrotizing lymphadenitis with hemophagocytosis. The pathological features were noted to be similar to those of patients reported to have severe fever with thrombocytopenia syndrome (SFTS). Therefore, the lymph node section was retrospectively tested immunohistochemically, revealing the presence of the SFTS virus (SFTSV) antigen. The sick cat showed similar symptoms and laboratory findings similar to those shown in human SFTS cases. The patient had no history of tick bites, and did not have skin lesions suggestive of these. She had not undertaken any outdoor activities. It is highly possible that the patient was infected with SFTSV through the sick cat’s bite. If a patient gets sick in an SFTS-endemic region after being bitten by a cat, SFTS should be considered in the differential diagnosis.