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不同预后的发热伴血小板减少综合征重症患者临床实验室指标对比分析

张鸿雁,  陈桂榴,  李文庭,  冷瑞雪,  秦薇子

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文章导航 > 中华疾病控制杂志  > 2020 >  24(3): 365-368
张鸿雁, 陈桂榴, 李文庭, 冷瑞雪, 秦薇子. 不同预后的发热伴血小板减少综合征重症患者临床实验室指标对比分析[J]. 中华疾病控制杂志, 2020, 24(3): 365-368. doi: 10.16462/j.cnki.zhjbkz.2020.03.022
引用本文: 张鸿雁, 陈桂榴, 李文庭, 冷瑞雪, 秦薇子. 不同预后的发热伴血小板减少综合征重症患者临床实验室指标对比分析[J]. 中华疾病控制杂志, 2020, 24(3): 365-368. doi: 10.16462/j.cnki.zhjbkz.2020.03.022
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ZHANG Hong-yan, CHEN Gui-liu, LI Wen-ting, LENG Rui-xue, QIN Wei-zi. Analysis on clinical laboratory indicators of different prognostic patients with severe fever with thrombocytopenia syndrome[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2020, 24(3): 365-368. doi: 10.16462/j.cnki.zhjbkz.2020.03.022
Citation: ZHANG Hong-yan, CHEN Gui-liu, LI Wen-ting, LENG Rui-xue, QIN Wei-zi. Analysis on clinical laboratory indicators of different prognostic patients with severe fever with thrombocytopenia syndrome[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2020, 24(3): 365-368. doi: 10.16462/j.cnki.zhjbkz.2020.03.022
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不同预后的发热伴血小板减少综合征重症患者临床实验室指标对比分析

doi: 10.16462/j.cnki.zhjbkz.2020.03.022
  • 1.

    230032 合肥, 安徽医科大学公共卫生学院流行病与卫生统计学系

  • 2.

    238000 巢湖, 安徽医科大学附属巢湖医院党委宣传科

  • 3.

    230001 合肥, 中国科学技术大学附属第一医院预防保健科

  • 4.

    230001 合肥, 中国科学技术大学附属第一医院感染科

基金项目: 安徽省重点研究与开发计划(1704e1002231)
详细信息
    通讯作者:

    秦薇子, E-mail:463946031@qq.com

    冷瑞雪, E-mail:lengruixue@ahmu.edu.cn

  • 中图分类号: R181

Analysis on clinical laboratory indicators of different prognostic patients with severe fever with thrombocytopenia syndrome

  • 1.

    Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China

  • 2.

    Propaganda Department of Party Committee, Chaohu Hospital of Anhui Medical University, Hefei 238000, China

  • 3.

    Department of Prevention and Health Protection, The First Affiliated Hospital of USTC, Hefei 230001, China

  • 4.

    Department of Infectious Diseases, The First Affiliated Hospital of USTC, Hefei 230001, China

Funds: Key Research and Development Plan of Anhui Province(1704e1002231)
More Information

    摘要
  • 摘要:   目的   分析新型布尼亚病毒感染致发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome, SFTS)患者的临床实验室资料, 重点比较重症不同预后患者的实验室指标差异, 为早期预测疾病预后提供理论依据。   方法   调查两所医院2011年1月-2018年12月收治的所有确诊患者的临床实验室指标, 并对数据作统计学分析。   结果   研究共纳入确诊研究对象168例, 其中非重症117例, 重症51例; 重症患者预后好转30例, 预后不良21例。对重症不同预后患者实验室检查指标进行比较分析, 发现多项指标有统计学差异。此外, 预后不良重症患者昏迷、弥漫性血管内凝血、心力衰竭等临床症状比例高于预后好转的重症患者(均有P < 0.05)。   结论   针对可能发生预后不良的重症患者制定差异化的防治方案。
    Abstract:   Objective   To analyze the clinical laboratory indicators of severe fever with thrombocytopenia syndrome(SFTS) patients caused by novel Bunyavirus infection, and focus on comparing the indicators of severe patients with different prognosis. The findings may help to predict poor prognosis for severe patients in the early stage.   Methods   The clinical laboratory indicators of all diagnosed confirmedly patients in two Hospitals, from January 2011 to December 2018, and the differences between groups were analyzed.   Results   A total of 168 clinically diagnosed SFTS cases(117 cases of non-severe cases and 51 cases of severe cases) were included in this study. In the severe cases, the prognosis was improved in 30 cases and the prognosis was poor in 21 cases. The laboratory indicators of severe patients with different prognosis were compared. The data showed that the levels of several indicators in patients with poor prognosis were statistically different with these in patients with better prognosis. In addition, the proportion of coma, diffuse intravascular coagulation and heart failure in patients with poor prognosis was significantly higher than that in patients with improved prognosis(all P < 0.05).   Conclusion   Differentiated prevention and treatment strategies should be developed for severe patients with possible poor prognosis.
    • HTML全文

  • 表  1  168例SFTS病例入院时的实验室指标比较分析

    Table  1.   Analysis on laboratory indicators on admission among 168 SFTS patients

    实验室指标 非重症患者 重症患者 t/Z值a P值
    WBC(109/L) 2.60(1.51, 3.98) 2.19(1.48, 4.06) -0.095 0.924
    RBC(109/L) 4.15(3.80, 4.58) 4.32(3.75, 4.63) -0.684 0.494
    N(109/L) 1.19(0.73, 2.16) 1.56(0.83, 2.58) -1.283 0.199
    L(109/L) 0.70(0.50, 1.18) 0.60(0.38, 1.32) -0.940 0.347
    EOS(109/L) 0.00(0.00, 0.02) 0.00(0.00, 0.01) -1.053 0.292
    HGB(109/L) 122.20(112.80, 137.00) 130.00(107.00, 141.00) -0.840 0.401
    CRP(mg/L) 5.28(3.04, 11.32) 6.10(4.95, 15.75) -1.532 0.126
    PLT(109/L) 45.00(31.20, 65.00) 35.00(20.00, 51.00) -3.009 0.003
    ALT (IU/L) 71.50(48.00, 136.75) 101.50(69.75, 211.70) -3.256 0.001
    AST(IU/L) 141.50(93.00, 244.25) 277.00(174.75, 515.00) -4.587 < 0.000 1
    GGT(IU/L) 29.00(19.00, 69.50) 63.90(34.00, 122.00) -3.270 0.001
    ALP(U/L) 58.50(45.00, 72.00) 77.00(47.00, 128.00) -2.764 0.006
    ALB(g/L) 33.95(30.35, 36.90) 32.45(28.68, 35.05) -2.016 0.044
    K(mmol/L) 3.63(3.32, 4.06) 3.77(3.47, 4.01) -1.150 0.250
    Na(mmol/L) 136.00(131.07, 140.00) 135.00(131.85, 138.00) -1.167 0.243
    Ca(mmol/L) 1.96(1.85, 2.04) 1.90(1.75, 2.00) -2.200 0.028
    P(mmol/L) 0.98(0.84, 1.13) 0.96(0.78, 1.19) 0.215 0.829
    GLU(mmol/L) 6.19(5.37, 7.30) 7.18(5.68, 9.42) -2.651 0.008
    Cr(Umol/L) 69.00(56.00, 87.00) 84.50(66.75, 121.50) -3.392 0.001
    BUN(Umol/L) 5.00(3.51, 7.30) 8.02(5.41, 10.93) -3.966 < 0.000 1
    LDH(U/L) 735.50(421.00, 995.00) 1 172.50(852.00, 1570.65) -4.179 < 0.000 1
    CK(IU/L) 350.00(180.00, 631.50) 869.50(385.50, 1603.75) -3.931 < 0.000 1
    CK-MB(U/L) 18.00(7.00, 34.30) 29.00(13.90, 56.35) -2.340 0.019
    PT(s) 12.40(11.60, 13.50) 13.10(12.40, 14.93) -2.555 0.011
    APTT(s) 42.50(35.50, 54.10) 57.4(44.05, 78.40) -4.384 < 0.000 1
    TT(s) 19.30(15.13, 22.73) 23.05(17.43, 48.38) -3.232 0.001
    FIB(g/L) 2.38(1.98, 2.93) 2.26(1.88, 2.91) -0.613 0.540
    U-PRO 1.00(0.00, 3.00) 2.00(0.50, 3.00) -1.428 0.153
    U-BLD 0.00(0.00, 1.00) 1.00(0.00, 2.00) -2.600 0.009
    注:a表示Z值为秩和检验计算的统计量。
    下载: 导出CSV

    表  2  51例重症不同预后SFTS病例实验室指标比较分析

    Table  2.   Analysis on laboratory indicators among 51 SFTS patients with different prognosis

    实验室指标 预后好转首次检查 预后不良首次检查 t/Z值 P值 预后好转末次检查 预后不良末次检查 t/Z值a P值
    WBC(109/L) 2.17(1.46, 4.06) 2.24(1.67, 4.10) -0.469 0.639 4.59(3.64, 6.55) 5.42(2.60, 7.76) -0.455 0.649
    RBC(109/L) 4.27(3.74, 4.72) 4.39(3.72, 4.58) -0.124 0.901 3.22±0.69 3.56±1.15 -1.158 0.257
    N(109/L) 1.41(0.72, 2.48) 1.72(1.09, 3.05) -1.273 0.203 2.56(1.95, 4.22) 3.05(1.68, 5.23) -0.881 0.378
    L(109/L) 0.54(0.39, 1.08) 0.9(0.35, 1.48) -0.450 0.653 1.43±0.48 1.27±0.82 0.780 0.442
    EOS(109/L) 0.00(0.00, 0.02) 0.00(0.00, 0.01) 0.388 0.698 0.00(0.02, 0.04) 0.00(0.00, 0.01) -2.551 0.011
    HGB(109/L) 122.94±24.62 125.68±22.00 -0.407 0.686 95.48±16.47 109.07±35.55 -1.598 0.123
    CRP(mg/L) 6.10(4.95, 13.75) 6.70(4.25, 47.53) -0.710 0.478 3.60(0.85, 14.97) 12.47(4.58, 48.93) -1.894 0.060
    PLT(109/L) 42.50(21.53, 56.38) 30.00(18.00, 44.00) -0.996 0.319 202.00(105.25, 296.73) 34.50(18.50, 50.25) -5.416 < 0.000 1
    ALT(IU/L) 96.80(63.50, 132.00) 160.00(82.00, 249.50) -1.946 0.052 72.50(36.50, 108.25) 129.00(74.50, 275.00) -3.011 0.003
    AST(IU/L) 201.00(143.00, 369.50) 363.00(233.50, 1 030.05) -2.506 0.012 54.00(30.75, 109.25) 615.00(237.00, 848.50) -4.749 < 0.000 1
    GGT(IU/L) 53.00(23.50, 110.50) 77.50(45.50, 122.88) -1.219 0.223 69.00(46.50, 140.00) 82.00(47.30, 193.50) -0.735 0.462
    ALP(U/L) 71.00(44.75, 100.15) 86.00(58.00, 156.50) -1.416 0.157 94.25±46.34 177.31±114.26 -2.576 0.020
    ALB(g/L) 32.70(27.00, 35.10) 31.80(28.95, 35.50) -0.049 0.961 33.20(30.25, 36.00) 27.20(26.25, 29.85) -3.765 0.000 2
    K(mmol/L) 3.66(3.44, 4.02) 3.79(3.51, 4.00) -1.005 0.315 3.87±0.58 4.06±0.93 -0.886 0.380
    Na(mmol/L) 134.36±4.94 135.42±4.95 -0.753 0.455 140.07±3.70 137.76±6.87 1.347 0.190
    Ca(mmol/L) 1.87±0.17 1.90±0.25 -0.429 0.670 2.06(1.95, 2.18) 1.87(1.85, 2.02) -3.008 0.003
    P(mmol/L) 0.94(0.78, 1.15) 0.99(0.75, 1.35) -0.536 0.592 0.90(0.72, 1.10) 1.06(0.91, 1.62) -2.063 0.039
    GLU(mmol/L) 7.00(5.95, 10.22) 7.36(5.45, 9.28) -0.265 0.791 5.55(4.94, 6.35) 8.18(6.36, 12.64) -2.914 0.004
    Cr(Umol/L) 76.50(62.75, 111.50) 103.50(70.25, 178.25) -1.802 0.072 59.50(48.75, 68.25) 114.00(85.00, 198.65) -4.263 < 0.000 1
    BUN(Umol/L) 6.50(4.01, 9.69) 9.61(6.90, 12.48) -2.555 0.011 4.75(3.02, 6.71) 11.30(7.40, 14.83) -3.233 0.001
    LDH(U/L) 927.00(666.00, 1 214.00) 1 578.60(1 204.00, 3 458.00) -3.692 < 0.000 1 407.00(354.50, 520.00) 2 024.50(1 252.75, 3 790.75) -4.611 < 0.000 1
    CK(IU/L) 780.00(392.00, 1 192.00) 1 397.00(366.00, 2 222.00) -1.740 0.082 240.00(69.00, 479.00) 1 495.00(683.00, 2 045.50) -4.072 < 0.000 1
    CK-MB(U/L) 23.00(13.30, 41.25) 37.50(16.50, 104.48) -1.891 0.059 13.00(5.40, 22.00) 56.60(37.05, 104.95) -3.598 < 0.000 1
    PT(s) 12.70(11.33, 14.05) 13.85(12.53, 15.88) -1.852 0.064 12.65(11.85, 13.75) 14.10(12.35, 16.11) -2.069 0.039
    APTT(s) 49.25(42.58, 61.90) 72.70(55.78, 115.15) -3.032 0.002 35.65(32.08, 47.45) 62.80(45.00, 124.60) -3.767 < 0.000 1
    TT(s) 20.65(15.23, 34.00) 29.85(22.48, 60.85) -2.457 0.014 16.65(13.85, 20.32) 26.50(20.05, 48.50) -3.314 0.001
    FIB(g/L) 2.28(1.89, 2.91) 2.07(1.45, 3.01) -1.194 0.232 3.12(2.25, 3.83) 1.56(1.20, 3.00) -2.863 0.004
    U-PRO 2.00(1.00, 3.00) 1.00(0.25, 3.00) -1.260 0.208 - - - -
    U-BLD 0.75(0.00, 2.00) 1.00(0.25, 2.00) -0.361 0.718 - - - -
    下载: 导出CSV

    表  3  51例不同预后重症SFTS病例临床症状分组分析

    Table  3.   Analysis on clinical features among 51 SFTS patients with different prognosis

    症状与体征 预后好转(N=30) (%) 预后不良(N=21) (%) χ2值 P值
    多脏器功能障碍 17(56.7) 16(76.2) 2.062 0.151
    意识障碍 14(46.7) 14(66.7) 1.996 0.158
    昏迷 3(10.0) 11(52.4) 11.141 0.001
    呼吸衰竭 5(16.7) 7(33.3) 1.093 0.296
    休克 6(20.0) 6(28.6) 0.140 0.708
    心力衰竭 3(10.0) 9(42.9) 5.698 0.017
    消化道出血 4(13.3) 5(23.8) 0.351 0.553
    弥漫性血管内凝血 1(3.3) 6(28.6) 4.684 0.030
    病毒性脑炎 5(16.7) 2(9.5) 0.100 0.752
    急性肾衰竭 2(6.7) 5(23.8) 1.789 0.181
    中毒性脑病 1(3.3) 2(9.5) 0.102 0.749
    败血症 1(3.3) 0(0.0) - -
    脑出血 0(0.0) 1(4.8) - -
    死亡 0(0.0) 3(14.3) - -
    下载: 导出CSV
    • 参考文献(9)
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