发热伴血小板减少综合征多脏器损伤的临床研究

目的探讨发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)多脏器损伤的特点及发生规律。方法收集68例SFTS的临床和实验室资料,对肝脏、心脏、血液系统、肾脏、脑等脏器损伤的症状和体征、生化指标进行动态分析。结果肝损伤发生率为97.06%(66/68)。早期、极期和恢复期ALT四分位数分别为76.6(44.1,126.0)、131.1(73.0,219.5)、120.6(74.3,199.0)U/L,AST四分位数分别为164.6(92.3,283.6)、249.5(107.5,426.0)、101.3(49.0,188.0)U/L。心肌酶变化以LDH和α-羟丁酸脱氢酶(α-HBDH)升高为主,早期、极期和恢复期LDH四分位数分别为677.5(389.0,1 412.5)、922.0(618.0,1 804.5)、470.0(306.0,733.0)U/L,α-HBDH四分位数分别为398.5(196.3,662.3)、584.0(372.5,895.0)、317.0(226.0,478.0)U/L,肌酸激酶同工酶基本正常。WBC降低、PLT减少发生率分别为67.65%和100%。早期、极期和恢复期WBC四分位数分别为2.56(1.00,6.40)、3.14(1.93,7.16)、4.22(3.11,6.34)×10~9/L,PLT四分位数分别为40.7(23.3,53.3)、40.0(25.2,51.3)、123.0(58.0,218.8)×10~9/L。27例尿潜血阳性,45例尿蛋白阳性,但肾功能指标肌酐和尿素氮无明显异常。11例意识状态改变,5例病理反射阳性。4例(5.88%)死亡,均死于多脏器功能衰竭。结论肝脏、心脏、肾脏、血液等器官系统损伤是SFTS的重要临床特征,在该病早期即出现损伤并持续加重,极期损伤最重,多数患者可逐渐恢复正常,少数患者可死于多脏器功能衰竭。

Multiple organ injury of severe fever with thrombocytopenia syndrome

Objective To investigate the characteristics and regularity of development of multiple organ injury in patients with severe fever with thrombocytopenia syndrome (SFTS). Methods Clinical and laboratory data of 68 SFTS patients were collected. Signs, symptoms and biochemical indicators of the liver injury, heart injury, blood system injury, kidney injury, brain injury and other organ injury were dynamically analyzed. Results Liver injury was found in 66 SFTS patients (97.06%). In the early, critical and recovery stages of SFTS, the quartiles of ALT were 76.6 (44.1, 126.0) U/L, 131.1 (73.0, 219.5) U/L and 120.6 (74.3, 199.0) U/L, respectively;the quartiles of AST were 164.6 (92.3, 283.6)U/L, 249.5 (107.5, 426.0) U/L and 101.3 (49.0, 188.0) U/L, respectively. Compared with other myocardial enzyme indicators, LDH and α-HBDH increased more obviously. In the early, critical and recovery stages of SFTS, the quartiles of LDH were 677.5 (389.0, 1 412.5) U/L, 922.0 (618.0, 1 804.5) U/L and 470.0 (306.0, 733.0) U/L, respectively;the quartiles ofα-HBDH were 398.5 (196.3, 662.3) U/L, 584.0 (372.5, 895.0) U/L and 317.0 (226.0, 478.0) U/L, respectively. CKMB basically re-mained normal. WBC and PLT decreased in 67.65%and 100%of the patients, respectively. In the early, critical and recovery stages of SFTS, the quartiles of WBC were 2.56 (1.00, 6.40)×109/L, 3.14(1.93, 7.16)×109/L and 4.22 (3.11, 6.34)×109/L, respectively;the quar-tiles of PLT were 40.7 (23.3, 53.3)×109/L, 40.0 (25.2, 51.3)×109/L and 123.0 (58.0, 218.8)×109/L, respectively. Twenty-seven patients had positive tests for urinary occult blood, and 45 patients for urinary protein. But creatinine and urea nitrogen of the most patients re-mained normal. Eleven patients had abnormal consciousness, and 5 patients had pathological reflex. Four patients (5.88%) died, with multiple organ failure as the cause of death. Conclusions The injuries to liver, heart, kidney, blood system and other organs are the important clinical features of SFTS. The injury begins at the early stage of the disease, becomes the most severe in the critical stage, alleviates and recovers gradually in the recovery stage. A small number of patients die of multiple organ failure.