发热伴血小板减少综合征病情和预后的影响因素分析-东南大学学报医学版

发热伴血小板减少综合征病情和预后的影响因素分析

单位：安徽医科大学附属六安医院, 六安市人民医院医学检验科, 安徽六安 237005

分类号：R558.2;R511;R441.3

出版年·卷·期（页码）：2024·43·第六期（845-852）

摘要：

目的:探索发热伴血小板减少综合征(SFTS)患者就诊早期各项指标对病情和预后的影响。方法:收集2023年至2024年六安市人民医院收治的183例SFTS患者的临床资料。根据临床资料分为非重症组112例和重症组71例,重症组进一步分为预后良好组和预后差组,然后比较分析各组患者入院早期的各项指标差异。结果:重症组年龄、病毒载量、PLT、PT、APTT、RATI、TT、FDP、D-dimer、CK、LDH、AST、IBL、Urea和Cr水平显著高于非重症组(P＜0.05),而血清Ca²⁺、Mon、Lym水平显著低于非重症组(P＜0.05);重症患者中预后差组患者的年龄、病毒载量、PT、APTT、RATI、TT、FDP、D-dimer、AST和IBL显著高于预后良好组(P＜0.05),且预后差组的肾功能不全、呼吸衰竭和休克比例明显高于预后良好组(P＜0.05)。多因素Logistic回归分析结果显示Lym水平的降低、TT和Cr水平的升高对SFTS患者的病情加重影响具有统计学意义(P＜0.05),IBL水平的增高对SFTS重症患者的不良预后影响具有统计学意义(P＜0.05)。结论:SFTS患者就诊早期Lym水平偏低,TT、IBL和Cr 值偏高,对于预测病情严重程度和不良预后有一定参考价值。另外提示临床医生在预防重症患者病情恶化时,可能需要警惕患者出现肾功能不全、呼吸衰竭和休克。

Objective: To explore the influence of early indicators in patients on the severity and prognosis of severe fever with thrombocytopenia syndrome(SFTS). Methods: The clinical data of 183 patients who were diagnosed as SFTS in Lu'an People's Hospital between 2023 and 2024 were collected. According to the clinical data, the patients were divided into 112 cases in the non-severe group and 71 cases in the severe group. The severe group was further divided into the good prognosis group and the poor prognosis group. Then, the differences in various indicators of each group in the early stage were compared and analyzed. Results: The age, Dabie bandavirus(DBV) load, PLT, PT, APTT, RATI, TT, FDP, D-dimer, CK, LDH, AST, IBL, Urea and Cr in the severe group were significantly higher than those in the non-severe group(P<0.05). The serum levels of Ca²⁺, Mon and Lym in the severe group were significantly lower than those in the non-severe group(P<0.05).The age, DBV load, PT, APTT, RATI, TT, FDP, D-dimer, AST and IBL in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05), and the proportion of patients with renal insufficiency, respiratory failure or shock in the poor prognosis group was significantly higher than that in the good prognosis group(P<0.05).Logistic regression analysis showed that the decrease of Lym and the increase of TT and Cr had a statistically significant effect on the exacerbation of SFTS patients(P<0.05). The increase of IBL had a statistically significant effect on the poor prognosis of severe SFTS patients(P<0.05). Conclusion: The low Lym level and the high TT, IBL and Cr values in the early stage of SFTS patients have certain reference value for predicting the severity of the disease and poor prognosis. In addition, clinicians may need to be alert to the occurrence of renal insufficiency, respiratory failure and shock when preventing the deterioration of the condition of critically ill patients.

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