辽宁省大连地区发热伴血小板减少综合征临床特征及预后影响因素研究

 目的 对大连地区发热伴血小板减少综合征（SFTS）患者的临床特征以及影响预后因素进行分析，为早期治疗降低病死率提供依据。方法 收集2018—2020年大连市疾病预防控制中心112例SFTS病例，其中存活病例79例，死亡病例33例，分析存活组与死亡组的临床特征、实验室指标，以及影响SFTS患者预后的因素。结果 共纳入112例患者，病死率为29.5%。年龄，合并糖尿病、高血压，房颤，住院时间死亡组与存活组相比，差异均具有统计学意义（均P<0.05）。临床症状中死亡组患者早期出现神经症状、出血表现比例高于存活组患者，实验室指标中钙离子、门冬氨酸氨基转移酶、丙氨酸氨基转移酶、乳酸脱氢酶、肌酐、尿素氮水平、凝血酶原时间、凝血酶原活动度、清蛋白、血小板、C-反应蛋白、病毒载量水平，死亡组与存活组比较差异均具有统计学意义（均P<0.05）。多因素logistic回归分析，病毒载量、神经系统症状、出血表现、肌酸激酶>170 U/L可作为预测SFTS患者预后的指标。结论 大连地区SFTS患者病死率较高，病毒载量、早期神经系统表现、出血表现和早期肌酸激酶>170 U/L可作为患者预后预测指标。大连地区高病死率的原因是否与病毒株和毒力差异，以及临床治疗差异等相关，需要进一步研究阐明。

Clinical characteristics and influencing factors for prognosis of fever with severe thrombocytopenia syndrome in Dalian,Liaoning Province

Objective To analyze the clinical characteristics and influencing factors for prognosis of patients with severe fever with thrombocytopenia syndrome (SFTS) in Dalian, and provide reference for early treatment to reduce mortality. Methods 112 cases of SFTS in Dalian Center for Disease Control and Prevention from 2018 to 2020 were collected, including 79 survival cases and 33 death cases, clinical characteristics, laboratory indicators and prognostic factors of SFTS patients in survival group and death group were analyzed. Results A total of 112 patients were included in analysis, mortality was 29.5%. There were significant difference in age, diabetes mellitus, hypertension, atrial fibrillation, and length of hospital stay between survival group and death group (all P<0.05). In clinical symptoms, the proportion of early neurological symptoms and bleeding in death group was higher than that in survival group; in laboratory indicators, including calcium ion, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatinine, urea nitrogen, prothrombin time, prothrombin activity, albumin, platelet, C-reactive protein, and virus load, difference between death group and survival group were all statistically significant (all P<0.05). Multivariate logistic regression analysis showed that viral load, neurological symptoms, bleeding and creatine kinase>170 U/L can be used to predict the prognosis of SFTS patients. Conclusion The mortality of SFTS patients in Dalian is high, viral load, early neurological manifestations, bleeding and early creatine kinase >170 U/L can be used as prognostic indicators. Whether the cause of high mortality of SFTS patients in Dalian is related to the difference of virus strain and virulence, as well as clinical treatment needs to be further studied.