重癥腎綜合征出血熱早期預(yù)警參數(shù)評(píng)估及預(yù)后風(fēng)險(xiǎn)模型的構(gòu)建
發(fā)布時(shí)間：2018-07-28 10:03
【摘要】：腎綜合征出血熱（hemorrhagic fever with renal syndrome, HFRS）是由漢坦病毒（Hantanvirus）引起的以發(fā)熱、出血及腎臟損害為特征的一類自然疫源性疾病。近3年來我國HFRS發(fā)病率逐年增高，作為陜西省HFRS高發(fā)區(qū)的關(guān)中地區(qū)，由漢灘病毒（hantaan virus，HTNV）感染所致的重癥HFRS多發(fā)，病死率高。 HTNV是漢坦病毒屬的主要血清型，也是陜西地區(qū)重癥HFRS的主要病原。截止目前，在西安地區(qū)僅發(fā)現(xiàn)由HTNV感染所致的HFRS病例。HFRS具有全身炎癥反應(yīng)綜合征（systemic inflammatory response syndrome，SIRS）的病理生理學(xué)特征；典型病理表現(xiàn)為血管滲漏綜合征，可導(dǎo)致水腫、休克、出血和急性腎小管間質(zhì)性腎炎。典型HFRS患者病程多經(jīng)歷五個(gè)階段：發(fā)熱期、低血壓休克期、少尿期、多尿期和恢復(fù)期。在一些重癥病例，發(fā)熱期、低血壓休克期和少尿期三期可以重疊，且易出現(xiàn)或合并難治性休克、急性腎損傷/腎衰竭（acute kidney injury, AKI/acute renalfailure, ARF）、呼吸衰竭、嚴(yán)重凝血障礙和多臟器功能障礙綜合征（multiple organdysfunction syndrome，MODS）。 雖然早在20世紀(jì)80年代已證明利巴韋林和α干擾素具有抗?jié)h坦病毒的功效，但由于該病早期診斷率低，入住醫(yī)院的患者大多在第4至第6病日以后，因此治療時(shí)機(jī)往往偏晚，用藥后難以觀察以明確療效，上述藥物迄今仍未在臨床廣泛應(yīng)用。早期發(fā)現(xiàn)、早期診斷、早期及就近支持治療仍是HFRS救治的主要原則。雖然國內(nèi)早在上世紀(jì)80年代制定了HFRS的臨床分型標(biāo)準(zhǔn)，其在該病防治中起到了十分重要的作用，但因于該分型標(biāo)準(zhǔn)中很多指標(biāo)均建立在病人主觀癥狀和醫(yī)生體檢的基礎(chǔ)上，不僅大多數(shù)參數(shù)未能量化，難以動(dòng)態(tài)及精確地評(píng)估HFRS病情變化及嚴(yán)重程度，而且難以早期預(yù)測(cè)病情的發(fā)展和趨勢(shì)，合理地指導(dǎo)醫(yī)師對(duì)患者進(jìn)行有效的治療干預(yù)。隨著當(dāng)代醫(yī)學(xué)檢驗(yàn)學(xué)、醫(yī)學(xué)影像學(xué)和重癥監(jiān)護(hù)技術(shù)的發(fā)展，HFRS救治過程中已經(jīng)有越來越多的實(shí)驗(yàn)室和儀器檢查項(xiàng)目和數(shù)據(jù)可供醫(yī)師選擇和參考，但同其它危重癥的診治一樣，如何高效簡(jiǎn)捷地選擇、整合和分析臨床上獲得的大量HFRS重癥患者的檢測(cè)數(shù)據(jù)和參數(shù)，并用于指導(dǎo)臨床治療，國內(nèi)外仍缺少相應(yīng)的研究。因此，進(jìn)一步深入探索和發(fā)現(xiàn)新的重癥HFRS早期預(yù)警指標(biāo)，對(duì)現(xiàn)有眾多的臨床及實(shí)驗(yàn)室參數(shù)進(jìn)行有效整合和分析，對(duì)重癥HFRS患者的病情及預(yù)后進(jìn)行早期預(yù)判，指導(dǎo)醫(yī)師采取實(shí)時(shí)有效的治療對(duì)策，，對(duì)提高HFRS危重患者的救治成功率具有重要和實(shí)際的意義。 本課題正是圍繞上述研究方向，評(píng)估目前臨床常規(guī)檢測(cè)的實(shí)驗(yàn)室參數(shù)在重癥HFRS早期預(yù)警及預(yù)后評(píng)估中的價(jià)值；分析危重型HFRS患者的臨床特征及預(yù)后；嘗試構(gòu)建基于臨床及實(shí)驗(yàn)室參數(shù)的預(yù)后風(fēng)險(xiǎn)模型；明確高遷移率族蛋白-1（high mobilitygroup box protein-1，HMGB-1）、脂聯(lián)素（adiponectin，APN）、鐵蛋白（ferritin，F(xiàn)RT）和正五聚素-3（pentraxin3，PTX-3）4個(gè)生物標(biāo)記物在重癥HFRS早期預(yù)警及預(yù)后評(píng)估中的價(jià)值。 1．重癥腎綜合征出血熱實(shí)驗(yàn)室參數(shù)早期預(yù)警評(píng)估及預(yù)后風(fēng)險(xiǎn)模型的構(gòu)建 建立HFRS臨床診療數(shù)據(jù)庫平臺(tái)，隨機(jī)調(diào)取2008年1月至2012年08月收治的356例典型HFRS患者的臨床診療數(shù)據(jù)。結(jié)合臨床分型標(biāo)準(zhǔn)，將納入患者分為輕型、中型、重型和危重型四組。將12個(gè)患者治療中常規(guī)檢測(cè)的實(shí)驗(yàn)室參數(shù)進(jìn)行分析，包括WBC、HGB、PLT、ALT、AST、ALB、BUN、SCr、UA、PT、APTT和Fib。研究?jī)?nèi)容包括：回顧性分析上述實(shí)驗(yàn)室參數(shù)在不同分型HFRS患者急性期的表達(dá)變化，評(píng)估其在重癥HFRS早期預(yù)警中的價(jià)值；分析各實(shí)驗(yàn)室參數(shù)與預(yù)后的相關(guān)性及對(duì)預(yù)后的影響程度和預(yù)測(cè)價(jià)值；篩選影響預(yù)后的獨(dú)立因素，并構(gòu)建基于實(shí)驗(yàn)室參數(shù)的預(yù)后風(fēng)險(xiǎn)模型。結(jié)果顯示： WBC、PLT、AST、ALB、BUN、SCr、PT和APTT等實(shí)驗(yàn)室參數(shù)在不同分型患者急性期表達(dá)水平出現(xiàn)明顯變化；WBC、AST、PT和Fib可作為HFRS患者預(yù)后的獨(dú)立影響因子；WBC、AST、PT和Fib聯(lián)合檢測(cè)評(píng)估HFRS患者預(yù)后的效力優(yōu)于單一參數(shù)檢測(cè)。 2．危重型腎綜合征出血熱的臨床特征及預(yù)后風(fēng)險(xiǎn)模型的構(gòu)建 將第一部分中觀察的356例HFRS患者中的75例危重型患者納入本部分研究。結(jié)合患者預(yù)后，將其分為存活組和死亡組。研究?jī)?nèi)容包括：回顧性比較存活組與死亡組患者在一般臨床特征、人口統(tǒng)計(jì)學(xué)及流行病學(xué)特征、癥狀、體征、影像學(xué)、體液、有創(chuàng)治療措施及并發(fā)癥等相關(guān)參數(shù)的差異；觀察患者的累計(jì)生存率及28天病死率；分析臨床參數(shù)與預(yù)后的相關(guān)性，對(duì)預(yù)后的影響程度；篩選影響預(yù)后的獨(dú)立因素，并構(gòu)建基于臨床參數(shù)的預(yù)后風(fēng)險(xiǎn)模型。結(jié)果顯示：危重型HFRS患者病程第2周的累計(jì)生存率為70.7%，28天病死率為36.3%；煩燥不安、球結(jié)膜出血、昏迷、心力衰竭、ARDS、腦病和ARF與預(yù)后相關(guān)性強(qiáng)；ARDS、球結(jié)膜出血和昏迷可作為危重型患者預(yù)后的獨(dú)立影響因素。 3．HMGB-1、APN、FRT和PTX-3在重癥腎綜合征出血熱早期預(yù)警及預(yù)后評(píng)估中的價(jià)值 隨機(jī)納入105例2011年10月至2012年12月收治的HFRS患者。抽取患者住院期間急性期靜脈血標(biāo)本93份，恢復(fù)期78份，抽取健康對(duì)照標(biāo)本28份，分離出血漿。應(yīng)用ELISA檢測(cè)HMGB-1、APN、FRT和PTX-3在不同分型HFRS患者急性期和恢復(fù)期的表達(dá)水平。研究?jī)?nèi)容包括：前瞻性觀察HMGB-1、APN、FRT和PTX-3四因子在不同分型患者急性期及恢復(fù)期的表達(dá)變化，與健康對(duì)照組的差異；評(píng)估其在HFRS早期預(yù)警中的價(jià)值；分析四因子間的相關(guān)性及與預(yù)后、實(shí)驗(yàn)室參數(shù)的相關(guān)性；評(píng)估四因子對(duì)預(yù)后的預(yù)測(cè)價(jià)值。結(jié)果顯示：HMGB-1、APN、FRT和PTX-3在不同分型患者急性期與恢復(fù)期表達(dá)水平出現(xiàn)明顯變化，且與WBC、PLT和ALB相關(guān)性強(qiáng)；除APN外，HMGB-1、FRT和PTX-3預(yù)測(cè)預(yù)后的AUC均大于0.800，F(xiàn)RT與PTX-3預(yù)測(cè)預(yù)后的價(jià)值高于WBC、PLT和ALB。 結(jié)論： 1.常規(guī)檢測(cè)WBC、PLT、AST、ALB、BUN、SCr、PT和APTT等實(shí)驗(yàn)室指標(biāo)有助于對(duì)重癥HFRS進(jìn)行早期預(yù)警；WBC、AST、PT和Fib可作為影響患者預(yù)后的獨(dú)立影響因子；WBC、AST、PT和Fib聯(lián)合檢測(cè)較單一參數(shù)檢測(cè)更有助于預(yù)測(cè)患者的預(yù)后； 2. ARDS、球結(jié)膜出血和昏迷可作為影響危重型HFRS患者預(yù)后的獨(dú)立影響因素，以此提醒醫(yī)師時(shí)刻警惕致命并發(fā)癥的發(fā)生，密切監(jiān)測(cè)并給予積極的對(duì)癥支持治療； 3. HMGB-1、APN、FRT和PTX-3均可作為重癥HFRS的早期預(yù)警因子；除APN外，檢測(cè)HMGB-1、FRT和PTX-3有助于評(píng)估及預(yù)測(cè)患者的預(yù)后。 4.本課題研究結(jié)果表明，聯(lián)合臨床及常規(guī)實(shí)驗(yàn)室參數(shù)檢測(cè)，探索并將HMGB-1、APN、FRT和PTX-3等生物標(biāo)記物應(yīng)用于臨床將更有助于重癥HFRS的早期預(yù)警及預(yù)后評(píng)估，為HFRS臨床分型標(biāo)準(zhǔn)的量化補(bǔ)充，制定新的HFRS臨床分級(jí)、分度量化標(biāo)準(zhǔn)提供更多循證醫(yī)學(xué)證據(jù)。
[Abstract]:Hemorrhagic fever with renal syndrome (HFRS) is a kind of natural epidemic disease characterized by fever, bleeding and kidney damage caused by Hantaan virus (Hantanvirus). In the past 3 years, the incidence of HFRS in China has increased year by year. As the Guanzhong area of the high incidence area of Shaanxi Province, Hantaan virus (Hantaan virus, HTNV) has been found. The severe HFRS caused by infection is high and the mortality rate is high.
HTNV is the main serotype of Hantavirus and is also the main pathogen of severe HFRS in Shaanxi. Up to now, only the HFRS case.HFRS caused by HTNV infection in Xi'an region has the pathophysiological characteristics of systemic inflammatory response syndrome (systemic inflammatory response syndrome, SIRS), and the typical pathological manifestation is vascular leakage. Syndrome, which can lead to edema, shock, bleeding and acute renal tubulointerstitial nephritis. Typical HFRS patients undergo five stages of disease: fever, hypotension, oliguria, polyuria, and recovery. In some severe cases, fever, hypotension, and oliguria, three stages can be overlapped, and easy to occur or combine refractory shock. Acute renal injury / renal failure (acute kidney injury, AKI/acute renalfailure, ARF), respiratory failure, severe coagulopathy and multiple organ dysfunction syndrome (multiple organdysfunction syndrome, MODS).
Although it has been proved in 1980s that Leigh Bhave Lin and IFN have the efficacy of anti hantavirus, but because of the low early diagnosis rate of the disease, most of the patients in the hospital are in the fourth to sixth days of the disease, so the time of treatment is often late, and it is difficult to observe the therapeutic effect after the drug use. Early diagnosis, early and near support therapy is still the main principle of HFRS treatment. Although the clinical classification standards of HFRS were established in 80s of last century, it has played a very important role in the prevention and treatment of the disease, but many of the indicators are based on the subjective symptoms of the patients and the basis of medical examination. On the other hand, most of the parameters are not quantified, and it is difficult to dynamically and accurately assess the changes and severity of the HFRS condition, and it is difficult to predict the development and trend of the disease early and to guide the doctor to intervene effectively in the patients. With the development of contemporary medical examination, medical imaging and intensive care technology, the HFRS treatment process More and more laboratory and instrument inspection projects and data are available for doctors to choose and refer, but like other critical diseases, it is necessary to select, integrate and analyze the data and parameters of a large number of HFRS critically ill patients, and to guide clinical treatment. Therefore, further exploration and discovery of the new early warning indicators for severe HFRS, effective integration and analysis of many existing clinical and laboratory parameters, early judgement on the condition and prognosis of severe HFRS patients, guiding physicians to take real time and effective treatment strategies, to improve the success rate of treatment for critical patients with HFRS Important and practical significance.
This topic is to evaluate the value of the laboratory parameters of clinical routine testing in the early warning and prognosis of severe HFRS, to analyze the clinical characteristics and prognosis of severe HFRS patients, to establish a prognostic risk model based on clinical and laboratory parameters, and to make clear the high mobility group protein -1 (high mob). Ilitygroup box protein-1, HMGB-1), adiponectin (adiponectin, APN), ferritin (ferritin, FRT) and positive five polymer -3 (pentraxin3, PTX-3) 4 biomarkers in the early warning and prognostic evaluation of severe HFRS.
Construction of early warning assessment and prognostic risk model for severe hemorrhagic fever with renal syndrome in 1.
The HFRS clinical diagnosis and treatment database platform was set up to randomly select the clinical data of 356 typical HFRS patients admitted from January 2008 to 2012. According to the clinical classification standard, the patients were divided into four groups of light, medium, heavy and severe. The laboratory parameters of the routine examination in the treatment of 12 patients were analyzed, including WBC, HGB, PLT, A. LT, AST, ALB, BUN, SCr, UA, PT, APTT, and Fib. included: a retrospective analysis of the changes in the expression of the above laboratory parameters in the acute phase of different types of HFRS patients, evaluation of its value in the severe HFRS early warning, the correlation between the parameters of the laboratory and the prognosis and the prognostic value and predictive value of the prognosis; The results show that WBC, PLT, AST, ALB, BUN, SCr, PT, APTT and other laboratory parameters have obvious changes in the acute phase of patients with different types, and WBC, AST, PT and Fib can be used as independent prognostic factors. The prognostic effect of HFRS is better than that of single parameter test.
2. the clinical characteristics and risk model of severe hemorrhagic fever with renal syndrome
356 of the 356 cases of severe severe patients in the first part of the first part were studied in this part. Combined with the prognosis of the patients, they were divided into the survival group and the death group. The study included a retrospective comparison of the general clinical features, demographic and epidemiological characteristics, symptoms, signs, imaging, and fluid, in the survival and death groups. The difference in the parameters related to invasive treatment and complications, the cumulative survival rate and the 28 day mortality rate, the correlation between the clinical parameters and the prognosis, the impact on the prognosis, the screening of independent factors affecting the prognosis, and the construction of a prognostic risk model based on the clinical parameters. The results showed that the course of the patients with severe severe HFRS The cumulative survival rate of second weeks was 70.7%, and the 28 day fatality rate was 36.3%; irritability, conjunctival hemorrhage, coma, heart failure, ARDS, encephalopathy and ARF were associated with the prognosis; ARDS, conjunctival hemorrhage and coma were independent prognostic factors for the prognosis of severe patients.
Value of 3.HMGB-1, APN, FRT and PTX-3 in early warning and prognosis evaluation of severe hemorrhagic fever with renal syndrome
105 cases of HFRS patients admitted from October 2011 to December 2012 were randomly selected. 93 samples of acute venous blood samples were collected during hospitalization, 78 recovered period, 28 healthy control specimens were extracted and hemorrhagic pulp was separated. The expression level of HMGB-1, APN, FRT and PTX-3 in the acute phase and recovery period of different types of HFRS patients was detected by ELISA. The contents included the content of the study. A prospective observation of the changes in the expression of the four factors of HMGB-1, APN, FRT and PTX-3 in the acute and convalescent stages of different types of patients, and the difference from the healthy control group; evaluate its value in the early warning of HFRS; analyze the correlation between the four factors and the correlation with the prognosis and the laboratory parameters; and evaluate the predictive value of the four factor to the prognosis. The expression levels of HMGB-1, APN, FRT and PTX-3 were significantly changed in the acute and recovery stages of different types of patients, and they were closely related to WBC, PLT and ALB. Except APN, HMGB-1, FRT and PTX-3 predicted the prognosis of AUC were greater than 0.800.
Conclusion:
1. routine tests of WBC, PLT, AST, ALB, BUN, SCr, PT and APTT are helpful to early warning of severe HFRS; WBC, AST, PT, and APTT are independent factors affecting the prognosis of patients.
2. ARDS, bulking conjunctiva bleeding and coma can be an independent factor affecting the prognosis of severe HFRS patients, in order to remind physicians to be vigilant for the occurrence of fatal complications, closely monitor and give positive symptomatic support treatment.
3. HMGB-1, APN, FRT and PTX-3 can be used as early warning factors for severe HFRS. Besides APN, detection of HMGB-1, FRT and PTX-3 can help assess and predict the prognosis of patients.
4. the research results show that the application of HMGB-1, APN, FRT and PTX-3 biomarkers in clinical and routine laboratory parameters detection, and the application of biomarkers such as FRT, and PTX-3 will be more helpful to the early warning and prognosis assessment of severe HFRS, for the quantitative supplement of the HFRS clinical classification standards, the formulation of a new HFRS clinical classification, and a more evidence-based criteria for quantitative quantification. Proof of medical evidence.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.8
本文編號(hào)：2149735
[Abstract]:Hemorrhagic fever with renal syndrome (HFRS) is a kind of natural epidemic disease characterized by fever, bleeding and kidney damage caused by Hantaan virus (Hantanvirus). In the past 3 years, the incidence of HFRS in China has increased year by year. As the Guanzhong area of the high incidence area of Shaanxi Province, Hantaan virus (Hantaan virus, HTNV) has been found. The severe HFRS caused by infection is high and the mortality rate is high.
HTNV is the main serotype of Hantavirus and is also the main pathogen of severe HFRS in Shaanxi. Up to now, only the HFRS case.HFRS caused by HTNV infection in Xi'an region has the pathophysiological characteristics of systemic inflammatory response syndrome (systemic inflammatory response syndrome, SIRS), and the typical pathological manifestation is vascular leakage. Syndrome, which can lead to edema, shock, bleeding and acute renal tubulointerstitial nephritis. Typical HFRS patients undergo five stages of disease: fever, hypotension, oliguria, polyuria, and recovery. In some severe cases, fever, hypotension, and oliguria, three stages can be overlapped, and easy to occur or combine refractory shock. Acute renal injury / renal failure (acute kidney injury, AKI/acute renalfailure, ARF), respiratory failure, severe coagulopathy and multiple organ dysfunction syndrome (multiple organdysfunction syndrome, MODS).
Although it has been proved in 1980s that Leigh Bhave Lin and IFN have the efficacy of anti hantavirus, but because of the low early diagnosis rate of the disease, most of the patients in the hospital are in the fourth to sixth days of the disease, so the time of treatment is often late, and it is difficult to observe the therapeutic effect after the drug use. Early diagnosis, early and near support therapy is still the main principle of HFRS treatment. Although the clinical classification standards of HFRS were established in 80s of last century, it has played a very important role in the prevention and treatment of the disease, but many of the indicators are based on the subjective symptoms of the patients and the basis of medical examination. On the other hand, most of the parameters are not quantified, and it is difficult to dynamically and accurately assess the changes and severity of the HFRS condition, and it is difficult to predict the development and trend of the disease early and to guide the doctor to intervene effectively in the patients. With the development of contemporary medical examination, medical imaging and intensive care technology, the HFRS treatment process More and more laboratory and instrument inspection projects and data are available for doctors to choose and refer, but like other critical diseases, it is necessary to select, integrate and analyze the data and parameters of a large number of HFRS critically ill patients, and to guide clinical treatment. Therefore, further exploration and discovery of the new early warning indicators for severe HFRS, effective integration and analysis of many existing clinical and laboratory parameters, early judgement on the condition and prognosis of severe HFRS patients, guiding physicians to take real time and effective treatment strategies, to improve the success rate of treatment for critical patients with HFRS Important and practical significance.
This topic is to evaluate the value of the laboratory parameters of clinical routine testing in the early warning and prognosis of severe HFRS, to analyze the clinical characteristics and prognosis of severe HFRS patients, to establish a prognostic risk model based on clinical and laboratory parameters, and to make clear the high mobility group protein -1 (high mob). Ilitygroup box protein-1, HMGB-1), adiponectin (adiponectin, APN), ferritin (ferritin, FRT) and positive five polymer -3 (pentraxin3, PTX-3) 4 biomarkers in the early warning and prognostic evaluation of severe HFRS.
Construction of early warning assessment and prognostic risk model for severe hemorrhagic fever with renal syndrome in 1.
The HFRS clinical diagnosis and treatment database platform was set up to randomly select the clinical data of 356 typical HFRS patients admitted from January 2008 to 2012. According to the clinical classification standard, the patients were divided into four groups of light, medium, heavy and severe. The laboratory parameters of the routine examination in the treatment of 12 patients were analyzed, including WBC, HGB, PLT, A. LT, AST, ALB, BUN, SCr, UA, PT, APTT, and Fib. included: a retrospective analysis of the changes in the expression of the above laboratory parameters in the acute phase of different types of HFRS patients, evaluation of its value in the severe HFRS early warning, the correlation between the parameters of the laboratory and the prognosis and the prognostic value and predictive value of the prognosis; The results show that WBC, PLT, AST, ALB, BUN, SCr, PT, APTT and other laboratory parameters have obvious changes in the acute phase of patients with different types, and WBC, AST, PT and Fib can be used as independent prognostic factors. The prognostic effect of HFRS is better than that of single parameter test.
2. the clinical characteristics and risk model of severe hemorrhagic fever with renal syndrome
356 of the 356 cases of severe severe patients in the first part of the first part were studied in this part. Combined with the prognosis of the patients, they were divided into the survival group and the death group. The study included a retrospective comparison of the general clinical features, demographic and epidemiological characteristics, symptoms, signs, imaging, and fluid, in the survival and death groups. The difference in the parameters related to invasive treatment and complications, the cumulative survival rate and the 28 day mortality rate, the correlation between the clinical parameters and the prognosis, the impact on the prognosis, the screening of independent factors affecting the prognosis, and the construction of a prognostic risk model based on the clinical parameters. The results showed that the course of the patients with severe severe HFRS The cumulative survival rate of second weeks was 70.7%, and the 28 day fatality rate was 36.3%; irritability, conjunctival hemorrhage, coma, heart failure, ARDS, encephalopathy and ARF were associated with the prognosis; ARDS, conjunctival hemorrhage and coma were independent prognostic factors for the prognosis of severe patients.
Value of 3.HMGB-1, APN, FRT and PTX-3 in early warning and prognosis evaluation of severe hemorrhagic fever with renal syndrome
105 cases of HFRS patients admitted from October 2011 to December 2012 were randomly selected. 93 samples of acute venous blood samples were collected during hospitalization, 78 recovered period, 28 healthy control specimens were extracted and hemorrhagic pulp was separated. The expression level of HMGB-1, APN, FRT and PTX-3 in the acute phase and recovery period of different types of HFRS patients was detected by ELISA. The contents included the content of the study. A prospective observation of the changes in the expression of the four factors of HMGB-1, APN, FRT and PTX-3 in the acute and convalescent stages of different types of patients, and the difference from the healthy control group; evaluate its value in the early warning of HFRS; analyze the correlation between the four factors and the correlation with the prognosis and the laboratory parameters; and evaluate the predictive value of the four factor to the prognosis. The expression levels of HMGB-1, APN, FRT and PTX-3 were significantly changed in the acute and recovery stages of different types of patients, and they were closely related to WBC, PLT and ALB. Except APN, HMGB-1, FRT and PTX-3 predicted the prognosis of AUC were greater than 0.800.
Conclusion:
1. routine tests of WBC, PLT, AST, ALB, BUN, SCr, PT and APTT are helpful to early warning of severe HFRS; WBC, AST, PT, and APTT are independent factors affecting the prognosis of patients.
2. ARDS, bulking conjunctiva bleeding and coma can be an independent factor affecting the prognosis of severe HFRS patients, in order to remind physicians to be vigilant for the occurrence of fatal complications, closely monitor and give positive symptomatic support treatment.
3. HMGB-1, APN, FRT and PTX-3 can be used as early warning factors for severe HFRS. Besides APN, detection of HMGB-1, FRT and PTX-3 can help assess and predict the prognosis of patients.
4. the research results show that the application of HMGB-1, APN, FRT and PTX-3 biomarkers in clinical and routine laboratory parameters detection, and the application of biomarkers such as FRT, and PTX-3 will be more helpful to the early warning and prognosis assessment of severe HFRS, for the quantitative supplement of the HFRS clinical classification standards, the formulation of a new HFRS clinical classification, and a more evidence-based criteria for quantitative quantification. Proof of medical evidence.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.8
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