发热伴血小板减少综合征21例死亡病例临床分析

目的总结发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)死亡病例的临床特征。方法回顾性分析21例死亡病例的临床特点和实验室检测结果。结果 71.4%的患者有基础性疾病,发病到死亡平均时间为9 d。主要临床表现为发热(100%)、厌食(90.5%)、乏力和肌肉酸痛(85.7%)、恶心和呕吐(61.9%)以及头痛和头晕(42.9%)等;90.5%的患者病程中出现神经系统损害表现,52.4%有肺部感染表现,47.6%出现出血症状。所有患者血小板降低,81.0%的患者外周血白细胞降低,79.2%的患者出现蛋白尿;81.0%的患者ALT升高,90.5%的患者AST升高。呼吸、循环衰竭为主要死亡原因。结论死亡患者病情进展迅速,入院时即有多器官功能损害的表现,诊疗过程中应予以重视。

Clinical characteristics of 21 deaths with severe fever with thrombocytopenia syndrome

Objective To summarize the clinical characteristics of deaths with severe fever with thrombocytopenia syndrome (SFTS). Method The clinical data and laboratory findings of 21 deaths with SFTS were analyzed retrospectively. Results Totally 71.4% of the patients had underlying diseases. The average interval from onset to death was 9 days. The main clinical symptoms were fever (100%), anorexia (90.5%), fatigue and muscle soreness (85.7%), nausea and vomiting (61.9%), headache and dizziness (42.9%), etc. Neurological symptoms were found in 90.5% of the patients, pulmonary infection in 52.4% of the patients and hemorrhagic manifestations in 47.6% of the patients. PLT and WBC decreased in 100% and 81.0% of the patients, respectively. Proteinuria was found in 79.2% of the patients. ALT and AST elevated in 81.0% and 90.5% of the patients, respectively. The main cause of deaths were respiratory and circulatory failures. Conclusions SFTS develops quickly in patients with death as their outcome, and multiple organ dysfunctions may occur on admission in those patients, which should be paid due attention to in the diagnosis and treatment of SFTS patients.