安徽省新布尼亞病毒感染患者的臨床特征回顧性研究
發(fā)布時間：2018-09-15 06:09
【摘要】：目的了解安徽省新布尼亞病毒感染患者的臨床特點(diǎn)、病重相關(guān)危險因素及死亡相關(guān)危險因素,增加臨床醫(yī)師對新布尼亞病毒感染的認(rèn)識及判斷病情和預(yù)后,為進(jìn)一步治療發(fā)熱伴血小板減少綜合征提供依據(jù)。材料與方法病例資料來源本次研究對象均來自安徽醫(yī)科大學(xué)附屬巢湖醫(yī)院與安徽醫(yī)科大學(xué)第一附屬醫(yī)院。105例新布尼亞病毒感染病例均來自于2012年1月1日至2015年12月31日安徽醫(yī)科大學(xué)附屬巢湖醫(yī)院及2014年1月1日至2015年12月31日安徽醫(yī)科大學(xué)第一附屬醫(yī)院住院病人。方法先收集2012年1月1日至2015年12月31日安徽醫(yī)科大學(xué)附屬巢湖醫(yī)院及2014年1月1日至2015年12月31日安徽醫(yī)科大學(xué)第一附屬醫(yī)院臨床疑似病例。然后選取105例確診病例納入研究。按照病情嚴(yán)重程度分為普通組、重癥組兩組,對流行病學(xué)資料、臨床癥狀及體征和實(shí)驗(yàn)室指標(biāo)進(jìn)行統(tǒng)計學(xué)分析。再按照疾病轉(zhuǎn)歸分為痊愈組、死亡組兩組,回顧性分析兩組在流行病學(xué)、臨床癥狀、體征和實(shí)驗(yàn)室指標(biāo)等方面的差異性;并且按照時間順序,把病程分為三個階段;分析每個階段死亡危險因素。對所有的滿足正態(tài)分布的計量數(shù)據(jù)采用均數(shù)±標(biāo)準(zhǔn)差,采用t檢驗(yàn)。不滿足正態(tài)分布的計量數(shù)據(jù)用中位數(shù)和全距表示,采用非參數(shù)檢驗(yàn)。分類變量用頻數(shù)或比例表示,計數(shù)資料用X2檢驗(yàn)或矯正的卡方檢驗(yàn)或Fisher確切概率法。對于所有分析,雙側(cè)P0.05認(rèn)為差異有統(tǒng)計學(xué)意義。結(jié)果從2012年1月至2015年12月,兩所醫(yī)院SFTS確診病例共為105例,男性58人(55.2%),女性46人(43.8%)。年齡為17-86歲。重癥組為72例,年齡為35-86歲。普通組為27例,年齡為17-81歲。兩組中兩者年齡差異有統(tǒng)計學(xué)意義(t=4.601,P=0.000)。其中所有觀察對象中,共出現(xiàn)27例死亡病例,病死率(case fatality rate,CFR)為25.7%,在死亡病例中,農(nóng)民占26例(96.3%),其女性占44.4%,農(nóng)民和非農(nóng)民職業(yè)及男女性別無統(tǒng)計學(xué)差異。安徽省SFTS發(fā)病主要集中在5-6月份,其次是10月份,呈雙高峰。其中蜱蟲叮咬史和發(fā)病前15天內(nèi)有戶外活動史在重癥組和普通組有顯著差異(χ2=11.269,P=0.009;χ2=23.165,P=0.000)。重癥組病人與普通組病人在發(fā)病至就診時間和住院天數(shù)兩方面兩者差異無統(tǒng)計學(xué)意義(t=1.647,P=0.186;t=20.275,P=0.165)。兩組病人在體溫恢復(fù)至正常的時間方面,二者差異均具有統(tǒng)計學(xué)意義(t=4.091,P0.001)。在頭疼、嘔吐、淋巴結(jié)腫大、意識障礙、凝血功能異常和蜱蟲叮咬史方面的差異有統(tǒng)計學(xué)意義(均有P0.05)。實(shí)驗(yàn)室指標(biāo)方面:ALT、AST、LDH、ALB、CK、淀粉酶(amylase,AMY)和脂肪酶(lipase,LIP)、蛋白尿、血尿、鉀離子水平和空腹葡萄糖水平差異具有統(tǒng)計學(xué)意義(均有P0.05)。嘔吐、意識障礙、發(fā)病前就有明確蜱蟲叮咬史和發(fā)病前15天明確的戶外活動史、高水平的AST和低水平的ALB是SFTS患者出現(xiàn)重癥結(jié)局的危險。死亡組與痊愈組比較,非實(shí)驗(yàn)室指標(biāo)中意識障礙和蜱蟲叮咬史是死亡危險因素;SFTSV感染患者可分三個階段:第一階段,無指標(biāo)顯示能與新布尼亞病毒感染死亡緊密相關(guān);在第二階段,高水平的谷草轉(zhuǎn)氨酶和低水平的白蛋白是與新布尼亞病毒感染死亡有關(guān)的因素;在疾病的晚期高水平的LDH是死亡危險因子;單用丙種球蛋白和利巴韋林治療SFTSV感染沒有臨床效果。結(jié)論發(fā)熱伴血小板減少綜合征(SFTS)是一種新出現(xiàn)的嚴(yán)重出血熱,首先在中國農(nóng)村地區(qū)出現(xiàn),臨床主要表現(xiàn)是發(fā)熱、乏力、精神萎靡、惡心、嘔吐、腹瀉等消化道癥狀,并伴有外周血白細(xì)胞、血小板減少,少數(shù)病例病情進(jìn)展快速,出現(xiàn)意識、凝血功能障礙等,最終可因多器官功能衰竭而死亡。本次研究得出安徽地區(qū)SFTS患者臨床表現(xiàn)與其他報道相似,但病情嚴(yán)重程度更嚴(yán)重。病死率為25.7%。這種新發(fā)傳染病已經(jīng)嚴(yán)重威脅到公眾健康。不管在重癥組還是在死亡組蜱蟲叮咬史均是危險因素,在沒有明確有效治療措施的當(dāng)今,避免蜱蟲叮咬是防止感染和傳播SFTSV的重要措施。本次研究全面分析了各個因素在各個階段對死亡結(jié)局的影響,并使用了多因素統(tǒng)計方法進(jìn)行分析。得出結(jié)果可助于臨床醫(yī)生對SFTSV感染患者死亡因子判斷,更好的把握患者病情發(fā)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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.8
本文編號：2244008
[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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.8
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