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。

Analysis of clinical data for patients with severe fever with thrombocytopenia syndrome with complications of brain symptoms

This study analyzed the demographic characteristics, clinical manifestations and changes in laboratory parameters in patients with severe fever with thrombocytopenia syndrome (SFTS), to provide evidence supporting early identification of SFTS in patients with brain symptoms. The data of confirmed cases of SFTS from four hospitals in Anhui Province from January 2013 to June 2018 were collected retrospectively. Confirmed cases of SFTS were divided into two groups according to the presence or absence of brain symptoms. The differences in clinical indexes between groups were tested with independent sample t-test, Mann Whitney test, chi square test or Fisher exact probability. A total of 208 SFTS cases included 62 cases with and 146 cases without brain symptoms. The mortality was 17.74% in patients with SFTS with brain symptoms and 5.48% in patients without brain symptoms. During the entire hospitalization period, significant differences were observed in 12 laboratory parameters between groups (all P<0.05). But in febrile period, 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) and PCT(Z=-2.647,P=0.008) were statistically higher in SFTS patients with brain symptoms. While 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) and FDP(Z=-2.829,P=0.002) were statistically lower. In the stage of multiple organ dysfunction, GRA(Z=-2.346,P=0.019), TB(Z=-3.199,P=0.001), CRP(Z=-2.605,P=0.009) and Ca(Z=-2.807,P=0.005)were statistically higher in the group with brain symptoms, while LYNP(Z=-2.790,P=0.005), RET(Z=-2.329,P=0.020) and AMY(Z=-2.144,P=0.032) were statistically lower. In the recovery period, CK(Z=-2.007,P=0.045) was statistically higher and PLT(Z=-2.856,P=0.004) and AMY(Z=-2.586,P=0.010) were statistically lower in the group with brain symptoms. Mortality was higher in the group with SFTS with brain symptoms than in the group without brain symptoms. During hospitalization, dynamic monitoring of changes in laboratory parameters of patients with SFTS should be intensified to identify patients with possible with brain symptoms as early as possible. Greater attention should be paid to changes in BUN, CREA and CO₂CP concentrations, especially in early stages of disease.