肾综合征出血热患者血清铁蛋白水平变化研究

目的观察不同分型及不同分期肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者血清铁蛋白(ferritin,FRT)水平变化,探讨其在重症HFRS早期预警及预后(死亡)评估中的作用。方法以空军军医大学第二附属医院传染科2011年10月—2013年12月收治的符合纳排标准的102例HFRS患者为研究对象,根据HFRS临床分型标准分为轻型、中型、重型和危重型4组,以28例健康志愿者为对照组。应用ELISA检测纳入患者急性期、恢复期及健康对照者的血清FRT水平。比较FRT在不同分型患者病程中的表达变化以及与对照组的差异;分析急性期FRT与常规实验室指标的相关性,评估其在反映HFRS疾病严重程度中的作用;采用Logistic回归分析构建基于急性期FRT和常规实验室指标的HFRS预后(死亡)风险模型,并应用ROC曲线评估模型及FRT对预后(死亡)的预测效力。结果纳入患者中,轻型17例、中型19例、重型27例、危重型39例。各组之间基线资料(年龄、性别、急性期采血时间)对比,差异无统计学意义(P>0.05)。各型HFRS患者急性期血清FRT水平均高于同型恢复期和对照组(P均<0.05),且随着病情加重逐渐增高,在危重型患者中表达最高(P<0.05)。HFRS患者急性期血清FRT水平与WBC、PLT、AST、APTT等常规实验室指标具有相关性,其中与PLT相关性最强(rs=-0.792,P=0.000)。应用Logistic回归分析构建HFRS预后(死亡)风险模型,最终进入模型的指标为WBC、AST和APTT。ROC曲线分析结果显示,急性期FRT对HFRS预后(死亡)的预测价值与WBC、PLT、AST、APTT等常规实验室指标相当,联合多个指标所构建的模型的预测价值高于单个指标。结论FRT在重症HFRS早期预警及预后(死亡)评估中具有重要价值,值得在临床推广应用。

Changes of serum ferritin levels in patients of hemorrhagic fever with renal syndrome

Objective To prospectively observe the changes of serum ferritin(FRT)levels in patients of hemorrhagic fever with renal syndrome(HFRS)of different types and in different stages,and to evaluate its value on early warning and prognosis(death)evaluation of severe HFRS.Methods A total of 102 HFRS patients who were treated in Department of Infectious Diseases,the Second Affiliated Hospital of Air Force Medical University from October 2011 to December 2013 were enrolled in this study,and they met the criteria for inclusion and exclusion.According to the HFRS criteria of clinical classification,the patients were divided into four groups:mild-type,moderate-type,severe-type and critical-type and 28 healthy volunteers were taken as the control group.ELISA was used to detect the serum FRT levels of healthy controls and HFRS patients in acute stage and convalescent stage.To evaluate the value of FRT in estimating the HFRS disease severity,the levels of FRT during the course of HFRS patients of different types and the difference between HFRS patients and healthy controls were compared,and the correlation between FRT in acute stage and conventional laboratory parameters was analyzed.Logistic regression analysis was used to construct the prognostic(death)risk model of HFRS based on FRT in acute stage and conventional laboratory parameters.The predictive effectiveness for prognosis(death)of FRT and risk model were evaluated using receiver operating characteristic(ROC)curve.Results Of the enrolled patients,17 cases were mild-type,19 cases were moderate-type,27 cases were severe-type and 39 cases were critical-type.There were no significant differences in baseline data(age,gender,blood acquisition time in acute stage)between groups(P>0.05).In all types of HFRS patients,the levels of serum FRT in acute stage were higher than those of the control group and in convalescent stage of same type(P<0.05),and gradually increased with the aggravation of the disease,the highest expression was observed in the critical-type patients(P<0.05).The levels of serum FRT of HFRS patients in acute stage were correlated with WBC,PLT,AST,APTT and other conventional laboratory parameters,and the correlation with PLT was the highest(rs=-0.792,P=0.000).The laboratory parameters finally included in the HFRS prognostic(death)risk model which was constructed by Logistic regression analysis were WBC,AST and APTT.The results of ROC curve analysis showed that the predictive value of FRT in acute stage for HFRS prognosis(death)was similar to that of WBC,PLT,AST,APTT and other conventional laboratory parameters,and the predictive value of the model constructed by multiple indicators was higher than that by single indicator.Conclusions FRT plays an important role in early warning and prognosis(death)evaluation of patients with severe HFRS,and it is worthy of clinical application.