安徽省新布尼亚病毒感染患者的临床特征回顾性研究

发布时间：2018-09-15 06:09

【摘要】：目的了解安徽省新布尼亚病毒感染患者的临床特点、病重相关危险因素及死亡相关危险因素,增加临床医师对新布尼亚病毒感染的认识及判断病情和预后,为进一步治疗发热伴血小板减少综合征提供依据。材料与方法病例资料来源本次研究对象均来自安徽医科大学附属巢湖医院与安徽医科大学第一附属医院。105例新布尼亚病毒感染病例均来自于2012年1月1日至2015年12月31日安徽医科大学附属巢湖医院及2014年1月1日至2015年12月31日安徽医科大学第一附属医院住院病人。方法先收集2012年1月1日至2015年12月31日安徽医科大学附属巢湖医院及2014年1月1日至2015年12月31日安徽医科大学第一附属医院临床疑似病例。然后选取105例确诊病例纳入研究。按照病情严重程度分为普通组、重症组两组,对流行病学资料、临床症状及体征和实验室指标进行统计学分析。再按照疾病转归分为痊愈组、死亡组两组,回顾性分析两组在流行病学、临床症状、体征和实验室指标等方面的差异性;并且按照时间顺序,把病程分为三个阶段;分析每个阶段死亡危险因素。对所有的满足正态分布的计量数据采用均数±标准差,采用t检验。不满足正态分布的计量数据用中位数和全距表示,采用非参数检验。分类变量用频数或比例表示,计数资料用X2检验或矫正的卡方检验或Fisher确切概率法。对于所有分析,双侧P0.05认为差异有统计学意义。结果从2012年1月至2015年12月,两所医院SFTS确诊病例共为105例,男性58人(55.2%),女性46人(43.8%)。年龄为17-86岁。重症组为72例,年龄为35-86岁。普通组为27例,年龄为17-81岁。两组中两者年龄差异有统计学意义(t=4.601,P=0.000)。其中所有观察对象中,共出现27例死亡病例,病死率(case fatality rate,CFR)为25.7%,在死亡病例中,农民占26例(96.3%),其女性占44.4%,农民和非农民职业及男女性别无统计学差异。安徽省SFTS发病主要集中在5-6月份,其次是10月份,呈双高峰。其中蜱虫叮咬史和发病前15天内有户外活动史在重症组和普通组有显著差异(χ2=11.269,P=0.009;χ2=23.165,P=0.000)。重症组病人与普通组病人在发病至就诊时间和住院天数两方面两者差异无统计学意义(t=1.647,P=0.186;t=20.275,P=0.165)。两组病人在体温恢复至正常的时间方面,二者差异均具有统计学意义(t=4.091,P0.001)。在头疼、呕吐、淋巴结肿大、意识障碍、凝血功能异常和蜱虫叮咬史方面的差异有统计学意义(均有P0.05)。实验室指标方面:ALT、AST、LDH、ALB、CK、淀粉酶(amylase,AMY)和脂肪酶(lipase,LIP)、蛋白尿、血尿、钾离子水平和空腹葡萄糖水平差异具有统计学意义(均有P0.05)。呕吐、意识障碍、发病前就有明确蜱虫叮咬史和发病前15天明确的户外活动史、高水平的AST和低水平的ALB是SFTS患者出现重症结局的危险。死亡组与痊愈组比较,非实验室指标中意识障碍和蜱虫叮咬史是死亡危险因素;SFTSV感染患者可分三个阶段:第一阶段,无指标显示能与新布尼亚病毒感染死亡紧密相关;在第二阶段,高水平的谷草转氨酶和低水平的白蛋白是与新布尼亚病毒感染死亡有关的因素;在疾病的晚期高水平的LDH是死亡危险因子;单用丙种球蛋白和利巴韦林治疗SFTSV感染没有临床效果。结论发热伴血小板减少综合征(SFTS)是一种新出现的严重出血热,首先在中国农村地区出现,临床主要表现是发热、乏力、精神萎靡、恶心、呕吐、腹泻等消化道症状,并伴有外周血白细胞、血小板减少,少数病例病情进展快速,出现意识、凝血功能障碍等,最终可因多器官功能衰竭而死亡。本次研究得出安徽地区SFTS患者临床表现与其他报道相似,但病情严重程度更严重。病死率为25.7%。这种新发传染病已经严重威胁到公众健康。不管在重症组还是在死亡组蜱虫叮咬史均是危险因素,在没有明确有效治疗措施的当今,避免蜱虫叮咬是防止感染和传播SFTSV的重要措施。本次研究全面分析了各个因素在各个阶段对死亡结局的影响,并使用了多因素统计方法进行分析。得出结果可助于临床医生对SFTSV感染患者死亡因子判断,更好的把握患者病情发展,降低患者病死率。
[Abstract]:Objective To investigate the clinical characteristics, risk factors and death-related risk factors of neo-Bunia virus infection in Anhui Province, and to increase the awareness of clinicians on neo-Bunia virus infection and to judge its condition and prognosis, so as to provide evidence for further treatment of fever with thrombocytopenia syndrome. The subjects were from Chaohu Hospital Affiliated to Anhui Medical University and the First Affiliated Hospital of Anhui Medical University. 105 cases of new Bunia virus infection were from Chaohu Hospital Affiliated to Anhui Medical University from January 1, 2012 to December 31, 2015 and from January 1, 2014 to December 31, 2015. Methods Clinical suspected cases were collected from Chaohu Hospital Affiliated to Anhui Medical University from January 1, 2012 to December 31, 2015 and the First Affiliated Hospital of Anhui Medical University from January 1, 2014 to December 31, 2015. Clinical data, clinical symptoms and signs, and laboratory indicators were analyzed statistically. The patients were divided into recovery group and death group according to the prognosis of the disease. The differences in epidemiology, clinical symptoms, signs and laboratory indicators between the two groups were analyzed retrospectively. Risk factors. All measurements satisfying the normal distribution were performed with mean-standard deviation and t-test. The measurements not satisfying the normal distribution were expressed with median and full distance, and non-parametric test. Classified variables were expressed with frequency or proportion, and the measurements were performed with Chi-square test or Fisher's exact probability method of X2 test or correction. Results From January 2012 to December 2015, there were 105 confirmed cases of SFTS in the two hospitals, 58 males (55.2%) and 46 females (43.8%). Age ranged from 17 to 86 years. 72 cases were in the severe group, aged 35 to 86 years. 27 cases in the general group and 17 to 81 years in the two groups. Among them, 27 cases of death occurred, the case fatality rate (CFR) was 25.7%. Among the death cases, 26 cases (96.3%) were peasants, and 44.4% were women. There was no statistical difference between peasants and non-peasants. The incidence of SFTS in Anhui Province was mainly from May to June, followed by October. There was a significant difference between the severe group and the ordinary group in the history of tick biting and outdoor activities within 15 days before the onset (_2 = 11.269, P = 0.009; _2 = 23.165, P = 0.000). There was no significant difference between the severe group and the ordinary group in the onset time and hospitalization days (t = 1.647, P = 0.186; t = 20.275, P = 0.165). There were significant differences between the two groups in the recovery time of body temperature (t = 4.091, P 0.001). There were significant differences in headache, vomiting, lymphadenopathy, disturbance of consciousness, abnormal coagulation function and tick bite history (P 0.05). Laboratory indicators: ALT, AST, LDH, ALB, CK, amylase (AMY) And lipase (LIP), proteinuria, hematuria, potassium levels and fasting glucose levels were statistically significant (all P 0.05). Vomiting, disturbance of consciousness, a clear history of tick bites before onset and a clear history of outdoor activities 15 days before onset, high levels of AST and low levels of ALB were at risk of severe outcomes in SFTS patients. Consciousness impairment and tick bite history were risk factors for death in non-laboratory indicators, and there were three stages in patients with SFTSV infection: in the first stage, no indicators showed a close correlation with the death of New Bunia virus infection; in the second stage, high levels of glutamic oxaloacetic transaminase and low levels of albumin were associated with New Bunia disease. Conclusion Fever with thrombocytopenia syndrome (SFTS) is a newly emerged severe hemorrhagic fever, which first appeared in rural areas of China, and the main clinical manifestation is episodes of SFTSV infection. Fever, fatigue, mental flaccidity, nausea, vomiting, diarrhea and other gastrointestinal symptoms, and accompanied by peripheral blood leukocytes, thrombocytopenia, a few cases of rapid progress, consciousness, coagulation dysfunction, and eventually can be due to multiple organ failure and death. The fatality rate was 25.7%. This new infectious disease has seriously threatened public health. Tick bite history is a risk factor in both severe and death groups. Avoiding tick bites is an important measure to prevent infection and spread of SFTSV in the absence of definite and effective treatment measures. The results can help clinicians to judge the death factors of SFTSV infected patients, grasp the development of patients'condition better, and reduce the mortality of patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.8

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