舟山海岛地区发热伴血小板减少综合征死亡病例特征和基因序列分析

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及病毒基因序列,为SFTS的防治提供科学依据。方法 应用病例-对照研究,对8例SFTS死亡病例(病例组)和24例存活病例(对照组)的临床与流行病学信息进行统计分析,利用MEGA5.1对毒株进行系统发育分析。结果 1)死亡病例组有田间劳作史的比例为50.00%,存活病例组为8.33%,二者有统计学差异(P=0.023),OR=11.00;死亡病例组家中养有动物且动物身上有蜱虫发现比例为37.50%,存活病例组为4.17%,二者有统计学差异(P=0.039),OR=13.80。2)死亡病例组中有畏寒症状比例为25.00%,存活病例组为79.17%,(P=0.02),OR=0.08;死亡病例组中有腹泻症状比例为37.50%,存活病例组为83.33%,(P=0.04),OR=0.12;死亡病例组中初诊有体表淋巴结肿大比例为50.00%,存活病例组为12.50%,(P=0.04),OR=7.00。3)死亡病例组及存活病例组白细胞、血小板均低于正常水平,死亡病例组血小板均值高于存活病例组,且二者有统计学差异(P=0.02)。4)日本与这4株死亡病例所在的岱山岛均为海岛环境,其L、M核苷酸序列处于同一个进化分支。然而基于S片段的进化树上江苏的代表株也进入到这个分支。结论 有田间劳作、家中动物身上有蜱虫及初诊体表淋巴结肿大的病例死亡风险较高,而有腹泻及畏寒症状的病例死亡风险较低,医务人员在诊治过程中应加以注意,另外布尼亚病毒在海岛环境上可能有比较独特的演化环境。

Epidemiology,clinical characteristics and gene sequence of fatal cases of severe fever with thrombocytopenia syndrome in Zhoushan island,China

In this paper, we explored the epidemiology, clinical characteristics and gene sequence of virus on fatal cases of severe fever with thrombocytopenia syndrome(SFTS), providing the basis for the scientific prevention and treatment of SFTS. The clinical and epidemiological information of 8 fatal cases(case group) and 24 non-fatal cases(control group) of SFTS were analyzed by statistics using case-control study and phylogeny was analyzed using MEGA5.1. Results showed that the proportions of field work history in case group and control group were 50% and 8.33%, respectively. There was statistical significance for field work history between two groups(P=0.023), OR=11.00. The proportions of raising animals and found ticks on animals in case group and control group were 37.5% and 4.17%, respectively. There was statistical significance for proportions of raising animals and found ticks on animals between two groups(P=0.039), OR=13.80. The proportions of clinical manifestation of chills in case group and control group were 25% and 79.17%, diarrhea were 37.50% and 83.33%, and lymphadenopathy were 50% and 12.5%, respectively. There were statistical significances for the clinical manifestations of chills, diarrhea and lymphadenopathy between two groups,(P=0.02, OR=0.08),(P=0.04, OR=0.12) and(P=0.04, OR=7.00), respectively. The mean of platelet counts in case group was higher than that in control group with statistical significance(P=0.02). The living environment of 4 fatal case patients which occurred in Daishan Island was island environmental, which was similar to Japan. Their L and M nucleotide sequence were in the same evolutionary branch. But, due to the represent strain of Jiangsu was also in the same evolutionary branch with Daishan Island and Japan on S fragment evolutionary tree. The patients who are raising animals and found ticks on animals, have field work history and lymphadenopathy are at higher risk of death. But the patitents with clinical symptoms of diarrhea and chills are at lower risk of death. The medical personnel should pay more attention in the process of diagnosis and treatment. In addition, the island environmental may provide unique environment of evolution for new bunyavirus.