肾综合征出血热患者循环内皮细胞CD95表达的临床研究

目的 探讨肾综合征出血热(HFRS)发热期和多尿期患者循环内皮细胞(CEC)中CD141、CD31及CD95的动态表达及临床意义.方法 应用流式细胞术分析不同型HFRS发热期和多尿期患者外周血细胞CD141、CD31及CD95的表达.多组数据的比较采用单因素方差分析.结果HFRS患者发热期和多尿期CD141+CD31+细胞(CEC)占外周血细胞的9.47%±1.98%和8.26%±1.55%.高于健康对照者的7.05%±1.45%(F=8.42;P=0.000,P=0.029),且发热期CD141+CD31+细胞较多尿期增高(P=0.48).HFRS发热期及多尿期患者CEC中CD95+细胞的平均荧光强度(MFI)较健康对照者明显升高(F=19.93;P=0.000,P=0.000),且发热期较多尿期明显增高(P=0.049).发热期各型患者CEC中CD95+细胞的MFI较健康对照者均明显增高(F=7.36;P=0.000),其中以重(危重)型患者最高,与中型和轻型比较差异有统计学意义(P=0.009,P=0.002).结论 CEC所占比例及CD95表达可能与HFRS病期及病情轻重有关.     

Hypocalcemia and hypercalcemia in patients with rhabdomyolysis with and without acute renal failure

Patients with rhabdomyolysis (RBD) and acute renal failure (ARF) are hypocalcemic during the oliguric phase of ARF and over 30% develop hypercalcemia during the diuretic phase. The present study examined the factors underlying these derangements in calcium metabolism in 15 patients: 7 with RBD and ARF, 4 with RBD only, and 4 with ARF only. All patients had hypocalcemia on admission and the hypocalcemia was more pronounced in those with RBD and ARF. All patients with RBD independent of the presence or absence of ARF had calcium deposition in soft tissues as documented by technetium-99 scan. In 4 patients with RBD and ARF, hypercalcemia developed during the diuretic phase at a time when Serum PTH levels were undetectable. Only patients with RBD and ARF had a significant increase in serum levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D [1,25(OH)2D] during the diuretic phase and both the increments in and the levels of 1,25(OH)2D were significantly greater in those who were hypercalcemic. The data indicate that 1) hypocalcemia occurs in RBD independent of ARF and is most likely related to calcium deposition in injured tissues, and 2) elevation in serum levels of 1,25(OH)2D plays an important role in the genesis of hypercalcemia during the diuretic phase of patients with RBD and ARF. Our observations suggest that extrarenal production of 1,25(OH)2D may occur in these patients, and/or that the renal production of 1,25(OH)2D may not be so tightly controlled as it is in normal subjects.     

Increased Plasma Cell-Free DNA Level during HTNV Infection: Correlation with Disease Severity and Virus Load

Cell-free DNA (cf-DNA) in blood represents a promising DNA damage response triggered by virus infection or trauma, tumor, etc. Hantavirus primarily causes two diseases: haemorrhagic fever with renal syndrome (HFRS) and Hantavirus cardiopulmonary syndrome (HCPS), depending on different Hantavirus species. The aim of this study was to evaluate plasma cf-DNA levels in acute phase of HFRS, and to correlate plasma cf-DNA with disease severity and plasma Hanttan virus (HTNV) load. We observed the appearance of cf-DNA in 166 plasma samples from 76 HFRS patients: the plasma cf-DNA levels peaked at the hypotensive stage of HFRS, and then decreased gradually. Until the diuretic stage, there was no significant difference in plasma cf-DNA level between patients and the healthy control. Exclusively in the febrile/hypotensive stage, the plasma cf-DNA levels of severe/critical patients were higher than those of the mild/moderate group. Moreover, the plasma cf-DNA value in the early stage of HFRS was correlated with HTNV load and disease severity. In most of the patients, plasma cf-DNA displayed a low-molecular weight appearance, corresponding to the size of apoptotic DNA. In conclusion, the plasma cf-DNA levels were dynamically elevated during HFRS, and correlated with disease severity, which suggests that plasma cf-DNA may be a potential biomarker for the pathogenesis and prognosis of HFRS.     

Mechanisms of disease in Hantavirus infection: pathophysiology of hemorrhagic fever with renal syndrome.

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease that occurs over wide areas of Europe and Asia. Hantaviruses are the cause of this syndrome. The hallmark of HFRS is the triad of fever, hemorrhage, and renal failure. In its severe form it is associated with significant mortality. The syndrome evolves through five phases: febrile, hypotensive, oliguric, diuretic, and convalescent. The central physiologic derangement in HFRS is vascular dysfunction, manifested by impaired vascular tone and increased vascular permeability. The systemic effects of this dysfunction account for the occurrence of hypotension and shock, while local effects are probably important in the development of renal failure. Shock in HFRS has distributive and oligemic features, while renal failure has features of acute tubular necrosis. Hemorrhage is a consequence of vascular injury and a deficit of functional platelets. Vascular and platelet dysfunction are both compounded by uremia. Disseminated intravascular coagulation contributes to hemorrhage in some patients. Although hantaviruses are infectious for endothelial cells and may cause direct injury, a large body of evidence suggests that immune mechanisms play an important role in the pathogenesis of HFRS.     

Hemorrhagic fever with renal syndrome: comparison of clinical course in Sweden and in the Western Soviet Union.

The severity of the clinical course in 355 Swedish and 603 Soviet patients with serologically confirmed hemorrhagic fever with renal syndrome (HFRS) was compared retrospectively. The overall frequency of hemorrhagic manifestations including also benign bleeding such as ecchymoses was higher among Soviet than among Swedish patients (37% vs. 10%). However, severe hemorrhagic complications (gastrointestinal and renal tract bleeding) were equally common in both countries. There were 2 fatal Soviet cases, whereas none of the Swedish patients died. We conclude that the clinical presentation of HFRS in Sweden and in the Western Soviet Union shows many similarities but there seems to be a higher frequency of life threatening complications among the patients in the Western USSR.     

Hormonal Defects Are Common during Puumala Hantavirus Infection and Associate with Disease Severity and Biomarkers of Altered Haemostasis

Central and peripheral hormone deficiencies have been documented during and after acute hantavirus infection. Thrombocytopenia and coagulation abnormalities are common findings in haemorrhagic fever with renal syndrome (HFRS). The associations between coagulation and hormonal abnormalities in HFRS have not been studied yet. Forty-two patients diagnosed with Puumala virus (PUUV) infection were examined during the acute phase and on a follow-up visit approximately one month later. Hormonal defects were common during acute PUUV infection. Overt (clinical) hypogonadism was identified in 80% of the men and approximately 20% of the patients had overt hypothyroidism. At the one-month follow-up visit, six patients had central hormone deficits. Acute peripheral hormone deficits associated with a more severe acute kidney injury (AKI), longer hospital stay and more severe thrombocytopenia. Half of the patients with bleeding symptoms had also peripheral hormonal deficiencies. Patients with free thyroxine levels below the reference range had higher D-dimer level than patients with normal thyroid function, but no thromboembolic events occurred. Acute phase hormonal abnormalities associate with severe disease and altered haemostasis in PUUV infection.     

肾综合征出血热患者循环内皮细胞中黏着斑激酶的表达

目的 检测肾综合征出血热(HFRS)患者循环内皮细胞(CEC)中磷酸化黏着斑激酶910(FAKps910)的表达.方法 50例HFRS患者按病情分为轻型17例,中型20例,危重型13例,另纳入健康对照组20例.Percoll密度梯度离心法分离内皮细胞,流式细胞技术检测APC-CD31特异性标记的CEC中FAKps910的表达.数据行单因素方差分析.结果 发热早期CEC中FAKps910阳性表达率为j9.87%±9.58%,健康对照组为21.14%±2.53%,发热期末或低血压休克期为11.64%±2.17%(F=262.31,P＜0.01),以后恢复至正常.发热期末或低血压休克期CEC中FAKps910的阳性率在轻型患者为17.45%±2.64%,中型为13.84%±2.54%,危重型为7.47%±2.57%,各型及与健康对照组之间差异均有统计学意义(F=52.642,P＜0.01).结论 HFRS患者CEC中黏着斑激酶(FAK)与病情轻重有关,FAKps910可能参与汉坦病毒引起的83整合素介导的血管内皮细胞损伤.     

Key differentiating features between scrub typhus and hemorrhagic fever with renal syndrome in northern China

Both scrub typhus and hemorrhagic fever with renal syndrome (HFRS) are severely epidemic in northern China and often present with acute undifferentiated fever. To correctly distinguish the two diseases at an early stage, we collected and compared clinical and routine laboratory data of 46 patients with confirmed scrub typhus and 49 patients with confirmed HFRS presenting to the outpatient departments of three town hospitals in northern China. Most patients with HFRS but none of the patients with scrub typhus had hemorrhagic manifestations. Retro-orbital pain, lumbar back pain, flank tenderness, proteinuria, and occult blood in urine often occurred in patients with HFRS. However, skin eschar, regional lymphadenopathy, and maculopapular rash were more commonly found in patients with scrub typhus. In addition, platelet counts in patients with HFRS were significantly lower than in patients with scrub typhus. These findings will be useful for physicians to distinguish scrub typhus from HFRS.     

肾综合征出血热患者血小板参数和功能指标的变化及其临床意义

目的 了解肾综合征出血热(HFRS)患者血小板参数和功能指标的变化规律，并探讨其临床意义。方法 使用美国ABBOTT公司cell—DYN3700血细胞分析仪对53例HFRS患者各病期的血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)和血小板压积(PCT)进行测定；使用TYXN-91型智能血液凝集仪测定1分钟聚集率(PAG1)、5分钟聚集率(PAG5)和最大聚集率(PAGM)。结果 发热初期MPV和PDW增加、PLT和PCT减少、血小板聚集功能减低，低血压休克期最为严重，之后回升，多尿期接近正常，恢复期基本正常。结论 对HFRS患者的血小板参数和功能指标进行动态监测，了解其消长规律，有利于判断患者的疾病状态，以便制定相应的治疗方案。     

肾综合征出血热患者血浆白细胞介素-18水平动态变化研究

目的检测肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者不同病期及不同临床型外周血中白细胞介素(interleukin,IL)-18浓度的变化,分析其与疾病的相关性,为研究HFRS的发病机制提供依据。方法收集唐都医院2011年10月—2014年1月81例不同临床型HFRS住院患者不同病期血样145份,同时选取15名健康志愿者作为正常对照,用酶联免疫吸附法检测其血浆中IL-18浓度,分析研究IL-18与其他检测指标的相关性。结果 HFRS患者血浆IL-18水平在发热期开始升高,少尿期达高峰,多尿期开始下降,但仍高于正常对照值;血浆IL-18水平在HFRS不同临床型之间都具有类似的变化趋势,急性期高于恢复期及正常对照值,恢复期高于正常对照值,且重型/危重型的变化更为明显。Spearman相关分析表明血浆IL-18水平与WBC和BUN水平呈中等程度正相关,与PLT呈中等程度负相关。结论 HFRS患者血浆IL-18水平与疾病严重程度及疾病进程密切相关,抑制IL-18的分泌可能会减轻机体的免疫病理损伤。     

Electrocardiographic changes in patients with haemorrhagic fever with renal syndrome

The purpose of the study was to assess the incidence, type and dynamics of electrocardiography (ECG) alterations in patients with haemorrhagic fever with renal syndrome (HFRS) according to different stages of the disease. 79 patients hospitalized at the University Hospital for Infectious Diseases in Zagreb during the large HFRS outbreak in Croatia in 2002 were retrospectively analysed. HFRS diagnosis was confirmed by enzyme-linked immunosorbent assay. A 12-lead resting ECG was obtained. 30 (38%) patients had abnormal ECG findings, most frequently in the oliguric stage. Increased levels of urea and creatinine were observed in all patients with abnormal ECG, along with abnormal chest X-ray in nearly 50% of cases. Sinus tachycardia was the most frequent ECG disorder in the febrile stage, and bradycardia in the oliguric stage. During the course of disease, some other ECG disorders were recorded: bundle branch conduction defects, non-specific ventricular repolarization disturbances, supraventricular and ventricular extrasystoles, prolonged QT interval, low voltage of the QRS complexes in standard limb leads, atrioventricular block first-degree, and atrial fibrillation. Myocarditis was present in 3 patients. In conclusion, abnormal ECG was found in more than one-third of HFRS patients with the most common findings during the oliguric stage. All ECG changes were transient.     

A study on pathogenesis and therapy of hemorrhagic fever with renal syndrome]

581 early cases of typical hemorrhagic fever with renal syndrome (HFRS) were dynamically studied on the clinical manifestations and laboratory findings from 1986 to 1989. All the patients were treated with various methods. The results showed: (1) The manifestations of microvascular damage, proteinuria and thrombocytopenia can be found at the first day of the onset in 80.0%, 72.2% and 33.3% respectively. In a word, the characteristic features of HFRS appear at the onset of the disease. (2) In 446 early cases the initial severity of the disease corresponded with the final severity at a rate of 89.2%; it indicated that the damage of HFRS may result from the first attack. (3) The time of the onset, peak and persistence of all the characteristic features were similar; it is suggested that the course of HFRS may be self-limited. (4) Based on the clinical understanding and the effective results in the 446 early cases treated with fluid therapy alone, we consider that the effective treatment of HFRS is early and reasonable fluid therapy.     

连续性肾脏替代治疗与间断性血液透析在重症肾综合征出血热治疗中的应用

目的回顾性观察连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)与间断性血液透析(intermittent hemodialysis,IHD)在重症肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者中的应用。方法依据临床分型标准,将2008年1月—2012年8月在我中心行血液净化治疗的147例重症HFRS患者分为重型组和危重型组;参照中华医学会ICU血液净化指南,对纳入患者行CRRT或IHD治疗,比较2组行CRRT或IHD治疗的病死率、并发症发生率和急性期的实验室指标。结果重型组患者均存活;危重型组患者行CRRT与IHD后的病死率比较差异无统计学意义(P=0.124);危重型组行CRRT的比例明显高于重型组(P0.001)。病程中存在重叠期的重症患者,行CRRT初始治疗的例数明显多于行IHD的例数,但其生存率比较差异无统计学意义(P=1.000)。CRRT组患者病情较IHD组重,其疾病本身的肾外并发症也较IHD组常见。结论 CRRT可广泛应用于危重型HFRS患者的救治。CRRT可有效减轻水负荷,稳定机体的血流动力学状态,将有助于使危重患者平稳地渡过急性期。     

Value of aldosterone receptor blockade in diuretic therapy of patients with chronic heart failure

PATHOGENESIS: All forms of chronic heart failure (high-output and low-output failure) are accompanied by an "arterial underfilling" inducing the activation of various neurohumoral systems (renin-angiotensin-aldosterone system, sympathic nervous system, non-osmotic stimulation of vasopressin). Elevated levels of those neurohormones detrimentally modulate renal function. Subsequently, renal salt and volume retention occurs leading to the main symptoms of heart failure, edema formation and dyspnea. DIURETIC THERAPY: Diuretics, which have been discovered more than 40 years ago, beneficially influence renal salt- and volume retention by their effects on tubular sodium reabsorption. While thiazides are recommended in mild forms, loop diuretics are used in severe stages of congestive heart failure. The clinician has to consider the changed pharmacokinetic and -dynamic properties during the application of diuretics in patients with chronic heart failure. In addition, increased sodium reabsorption occurs immediately after cessation of diuretic action often nullifying the preceding diuresis. Thus, salt- and volume restriction should be guaranteed, and a regular application of loop diuretics during the day should be preferred due to the short-acting nature of currently available loop diuretics. Sometimes, diuresis does not longer occur during the treatment with one substance (diuretic resistance), although the therapeutic goals of water excretion have not been achieved. After ruling out factors reducing the actions of diuretics (non-compliance, hyponatremia, etc.), a sequential nephron blockade should be initiated (combination of loop diuretics and a thiazide or an aldosterone-receptor antagonist) to increase diuresis and to elevate symptoms of volume overload. SIDE EFFECTS: Loop diuretics and thiazides often induce mild hypokalemia, which has been demonstrated to be not as benign as thought before. Chronic treatment with oral potassium supplements has several drawbacks, as urine excretion of potassium is subsequently increased and supplementation is not as effective as believed. Diuretic-induced hypokalemia seems to be aldosterone dependent. As aldosterone levels increase during diuretic therapy even during chronic treatment with an angiotensin-converting enzyme (aldosterone-escape) a combined treatment including an aldosterone-receptor antagonist has been suggested. Beneficial effects of aldosterone-receptor blockade on mortality (RALES trial) appear to be mediated be extrarenal and renal mechanisms. The suggested beneficial renal mechanisms of aldosterone receptor blockade are discussed in detail in the review. CONCLUSION: In conclusion, diuretic therapy of patients with congestive heart failure is effective to relieve symptoms and, presumably, to prolong life. As renal function and pharmacokinetics and -dynamics of diuretics are changed in heart failure, diuretic treatment has to be adapted to provide optimal treatment. Increased levels of aldosterone appear to play an important role in diuretic-induced hypokalemia, and in the progression of heart and renal failure. Thus, aldosterone receptor antagonists should be used in the treatment of heart failure more frequently.     

Bleeding manifestations in severely thrombocytopenic children with immune thrombocytopenic purpura

OBJECTIVE: To report the observations on various bleeding manifestations in children with immune thrombocytopenic purpura (ITP) having severe thrombocytopenia (platelet count (PC) < 20,000/microl) and to compare the differences in bleeding manifestations at levels of PC at < 10,000/microl compared with between 10,000 and 20,000/microl. STUDY DESIGN: It is a retrospective analysis of bleeding manifestations in children with ITP (n = 58) having severe thrombocytopenia recorded between July 1999 and June 2002. A total of 164 episodes of severe thrombocytopenia were observed. During 31 episodes (18.9%), no bleeding manifestations were observed. When bleeding was observed cutaneous bleeds were the commonest manifestations occurring in 124 episodes. Of these 124 instances, in 82 (66.1%) episodes only cutaneous bleeding was observed while in remaining 42 (33.9%) episodes cutaneous bleeding was associated with other bleeding sites. Other common bleeds observed included epistaxis 22 (13.4%), oral bleeding 21 (12.8%) and gastro-intestinal bleeding 5 (3.04%). Comparison of the bleeding manifestations during episodes when the PC was < 10,000/microl and those between 10,000 and 20,000/microl showed that in 76.6% episodes with the count at > 10,000/microl no or only cutaneous bleeds were observed (clinically mild disease) compared to 59.45% episodes with episodes having PC < 10,000/microl (z score 2.37, p < 0.05). There was no statistically significant difference in proportion of patients having clinically mild disease during acute or chronic phase of the disease. CONCLUSION: During episodes of severe thrombocytopenia, most children have clinically mild disease. When the PC is < 10,000/microl clinically mild disease is observed less often compared to episodes with PC 10,000-20,000/microl. Based on these observations, it can be recommended that during severe thrombocytopenia, particularly when the PC is between 10,000-20,22,000/microl, patients can be safely managed with watchful waiting without any specific therapeutic intervention.     

Epidemic hemorrhagic fever with renal syndrome in Yugoslavia, 1986

An epidemic of hemorrhagic fever with renal syndrome (HFRS) occurred in Yugoslavia May-November 1986; all Republics and Provinces were involved. Serum samples were received from 260 of 276 persons with symptoms clinically compatible with a diagnosis of HFRS. Presumptive infection with a hantavirus was determined serologically for 161 of these. Many patients with serious clinical pictures, including severe renal insufficiency and shock, were hospitalized; 11 died. Indirect fluorescent antibody tests with antigens of 4 hantaviruses (Hantaan, Fojnica, Puumala, and the Vranica strain of Puumala virus) showed that greater than 1 serotype was circulating during this epidemic. Hantavirus antigens were detected in the lungs of 86 of 302 (28.5%) wild-caught small mammals.     

Systemic lupus erythematosus: analysis of disease activity in 55 patients with end-stage renal failure treated with hemodialysis or continuous ambulatory peritoneal dialysis. Dutch Working Party on SLE

PURPOSE: To compare disease activity in patients with systemic lupus erythematosus (SLE) (1) before and after the onset of end-stage renal failure and (2) during hemodialysis and continuous ambulatory peritoneal dialysis (CAPD). PATIENTS AND METHODS: Records of 55 patients with SLE currently being treated with dialysis were reviewed. Disease activity was measured according to the SLE Disease Activity Index, event rates per 1,000 months' patient observation, and use of medication. RESULTS: In the majority of patients, deterioration of renal function was slowly progressive over more than 2 years. After the initiation of dialysis for end-stage renal failure, maximal extrarenal disease activity and use of medication decreased markedly, but event rates for specific nonrenal manifestations of lupus did not decrease. Overall survival with dialysis was 89% after 5 years. During dialysis no difference was found in disease activity and use of medication between treatment with either hemodialysis of CAPD. Thrombocytopenia and elevated levels of anti-double-stranded DNA, however, occurred more frequently during CAPD. CONCLUSION: Patients with SLE have excellent survival rates with dialysis; their disease activity is diminished during dialysis but not abolished. No difference in survival or disease activity was found between patients undergoing hemodialysis or CAPD.     

The clinical and epidemiologic features in 140 patients with lupus nephritis in a predominantly black population from one center in Kingston, Jamaica

BACKGROUND: Lupus nephritis has emerged as a major factor in the overall survival of patients and may help to explain the poor prognosis associated with systemic lupus erythematosus (SLE) in black patients. METHODS: The authors reviewed the clinical and epidemiologic features of lupus nephritis in 130 women and 10 men who were mainly of African descent. RESULTS: The mean (standard deviation) age at diagnosis of SLE was 27.9 (10.3) years. The majority of patients (75%) developed renal involvement within 1 year of presentation with SLE. The most frequent extrarenal manifestations were arthritis (67%), malar rash (44%), serositis (41%), and neurologic disorders (30%). Class IV nephritis was the most common glomerular lesion, accounting for 49% of the biopsies, with class II accounting for a further 23%. Proteinuria was a common feature at presentation in all classes. Nephrotic range proteinuria was most common in classes III and IV. Prevalence of nephrotic range proteinuria was similar in classes II (23%) and V (19%). Hematuria occurred in more than one half of the patients with classes II, IV, and V disease. Fifty-nine percent of the patients had renal impairment at the time of renal biopsy. The prevalence of hypertension, the nephritic syndrome, and renal impairment was significantly higher in class IV patients compared with all the other groups. Factors that were significantly associated with classes III and IV disease compared with the other classes on univariate analysis were renal impairment, proteinuria (but not in nephrotic range), low C3 levels, and anemia. CONCLUSIONS: The clinical features of the study patients were similar to those of patients belonging to other ethnic groups, but a high proportion of the study patients had renal impairment at the time of renal biopsy.     

Hemorrhagic fever with renal syndrome in the Dolenjska region of Slovenia--a 10-year survey.

This report describes the first investigation of clinical findings for a larger series of patients with hemorrhagic fever with renal syndrome (HFRS) who were infected with Dobrava virus. From 1985 to 1995, 38 patients with serologically confirmed HFRS were hospitalized at the regional hospital in Novo mesto in the Dolenjska region of Slovenia. On the basis of results of serological examination, 24 patients had Dobrava virus infection, and 14 patients had Puumala virus infection. Complete clinical data were available for 31 patients. Eleven patients underwent hemodialysis for treatment of acute oliguric or anuric renal failure. Four patients, all infected by Dobrava virus, had signs of shock and severe bleeding. Three severely ill Dobrava virus-infected patients died of hemorrhagic complications. We have demonstrated that Dobrava and Puumala viruses coexist in a single region of endemicity and are capable of causing HFRS with significant differences in severity.     

哈尔滨地区肾综合征出血热患者临床特征及感染的汉坦病毒血清型分析

目的研究哈尔滨地区肾综合征出血热患者的流行病学、临床特征及感染的汉坦病毒的血清型。方法对哈尔滨地区87例肾综合征出血热患者的流行病学资料、临床表现、实验室检查、转归等进行回顾性分析,并对发病5 d内患者感染的汉坦病毒血清型进行分析。结果87例患者中74.7%为农民.14.9%为林业工人.6.9%为学生、干部职员,3.4%为居民;农村56例,林区13例,郊区9例,城市9例。临床表现发热87例(100%),头痛44例(50.6%),腰痛35例(40.2%),眼眶痛17例(19.5%),恶心呕吐79例(90.8%),皮下出血点、淤斑29例(33.3%),少尿52例(59.8%),黑便35例(40.2%),腹痛26例(29.9%),腹胀61例(70.1%),抽搐2例(2.3%),呼吸困难4例(4.6%),三红征40例(46.0%),肾区叩痛52例(59.7%),球结膜水肿47例(54.0%)。实验室检查肝功能异常70例(80.5%);心肌酶学升高80例(92.0%);血糖异常53例(60.7%)。患者感染的汉坦病毒血清型,汉滩病毒占34.8%,汉城病毒占65.2%。结论哈尔滨地区肾综合征出血热的流行病学和临床特征的改变可能与汉坦病毒血清型的变化有关。