新型布尼亚病毒感染致发热伴血小板减少综合征的流行病学特征及预后影响指标分析
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摘要
目的通过对新型布尼亚病毒感染致发热伴血小板减少综合征(SFTS)的流行病学特征及预后影响指标分析,为该病的预防控制和诊疗提供参考依据。方法收集大连地区2012年-2017年新型布尼亚病毒感染致发热伴血小板减少综合征的确诊病例资料,对其流行病学特征、临床表现和并发症进行描述性分析,用成组t(t′)检验或Mann-Whitney U检验比较治愈组和死亡组治疗前的各项实验室检查指标的差异,采用logistic回归分析影响预后的相关指标。结果新型布尼亚病毒感染在大连地区高发时间为7-9月,北三市区为高发地域,农民或无业人员为高发人群,且年龄集中在55～75岁,病死率为10.69%～25.71%。治愈组和死亡组患者年龄及治疗前的活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、肌酸激酶同工酶(CKMB)、LDH指标水平比较差异有统计学意义(P<0.05);PT(OR=1.345,P=0.017)、APTT(OR=4.810,P=0.007)是影响预后的相关指标。结论在大连地区SFTS的流行病学特征明显。患者治疗前的PT、APTT是发热伴血小板减少综合征患者的预后影响指标。
OBJECTIVE To investigate the epidemiological characteristics of severe fever with thrombocytopenia syndrome(SFTS)caused by novel bunyavirus infection and analyze the influence factors for prognosis so as to provide guidance for prevention and treatment of the disease.METHODS The medical data were collected from the patients who were diagnosed with SFTS induced by novel bunyavirus infection and were treated in hospitals of Dalian from 2012 to 2017,the descriptive analysis was carried out for the epidemiological characteristics,clinical manifestation and complications,the laboratory examination indexes were observed and compared between the cured group and the death group by means of group t(t′)test or Mann-Whitney U test,and the logistic regression analysis was performed for the influence factors for prognosis.RESULTS The novel bunyavirus infection was highly prevalent in July-September in Dalian,the unburn areas of three north cities were the peak areas,farmers and unemployed people were the highly prevalent populations and were aged between 55 and 75 years old;the mortality rate ranged between 10.69% and 25.71%.There were significant differences in the age,activated partial thromboplastin time(APTT),thrombin time(TT),prothrombin time(PT),creatine kinase isoenzyme(CKMB)level and LDH level between the cured group and the death group before the treatment(P<0.05).PT(OR=1.345,P=0.017)and APTT(OR=4.810,P=0.007)were the influence factors for prognosis.CONCLUSION The disease shows unique epidemiological characteristics in Dalian.The PT and APTT are the influence factors for the prognosis of the patients with SFTS.
OBJECTIVE To investigate the epidemiological characteristics of severe fever with thrombocytopenia syndrome(SFTS)caused by novel bunyavirus infection and analyze the influence factors for prognosis so as to provide guidance for prevention and treatment of the disease.METHODS The medical data were collected from the patients who were diagnosed with SFTS induced by novel bunyavirus infection and were treated in hospitals of Dalian from 2012 to 2017,the descriptive analysis was carried out for the epidemiological characteristics,clinical manifestation and complications,the laboratory examination indexes were observed and compared between the cured group and the death group by means of group t(t′)test or Mann-Whitney U test,and the logistic regression analysis was performed for the influence factors for prognosis.RESULTS The novel bunyavirus infection was highly prevalent in July-September in Dalian,the unburn areas of three north cities were the peak areas,farmers and unemployed people were the highly prevalent populations and were aged between 55 and 75 years old;the mortality rate ranged between 10.69% and 25.71%.There were significant differences in the age,activated partial thromboplastin time(APTT),thrombin time(TT),prothrombin time(PT),creatine kinase isoenzyme(CKMB)level and LDH level between the cured group and the death group before the treatment(P<0.05).PT(OR=1.345,P=0.017)and APTT(OR=4.810,P=0.007)were the influence factors for prognosis.CONCLUSION The disease shows unique epidemiological characteristics in Dalian.The PT and APTT are the influence factors for the prognosis of the patients with SFTS.
引文
[1]宋丽华,齐上,庞为,等.大连市发热伴血小板减少综合征流行病学特征分析及控制对策[J].医学动物防制,2012,28(12):1325-1327.
[2]Kim KH,Yi J,Kim G,et al.Severe fever with thrombocytopenia syndrome,South Korea,2012[J].Emerg Infect Dis,2013,19(11):1892-1892.
[3]曾庆球,王秋景,张剑静,等.发热伴血小板减少综合征死亡危险因素分析[J].中华传染病杂志,2017,35(6):336-340.
[4]魏艳艳,邹桂舟,叶珺,等.新型布尼亚病毒感染病原学检测与预后研究[J].中华医院感染学杂志,2016,26(23):5339-5341.
[5]马婷.浙江省新型布尼亚病毒感染与死亡危险因素的病例对照研究[D].宁波大学,2016:1-70.
[6]中华人民共和国卫生部.发热伴血小板减少综合征防治指南(2010版)[J].中华临床感染病杂志,2011,4(4):193-194.
[7]中华人民共和国卫生部.发热伴血小板减少综合征诊疗方案[J].中国实用乡村医生杂志,2011,18(5):19-20.
[8]Wang T,Li XL,Liu M,et al.Epidemiological characteristics and environmental risk factors of severe fever with thrombocytopenia syndrome in Hubei province,China,from 2011to2016[J].Front Microbiol,2017,8:387.
[9]徐哲,崔宁,陈威巍,等.422例发热伴血小板减少综合征临床特点分析[J].传染病信息,2015,28(1):28-32.
[10]王建跃,邬辉,仝振东,等.发热伴血小板减少综合征流行病学研究进展[J].中华流行病学杂志,2016,37(2):294-298.
[11]李德新.发热伴血小板减少综合征布尼亚病毒概述[J].中华实验和临床病毒学杂志,2011,25(2):81-84.
[12]陈国胜,胡立芬,许夕海,等.新型布尼亚病毒感染致发热伴血小板减少综合征临床特点及预后影响指标[J].中国医学装备,2017,14(5):94-97.
[13]陈芬芳,陈华忠,林希,等.以肾功能损害为主要表现的新型布尼亚病毒感染患者的临床分析[J].中华传染病杂志,2013,31(3):179-180.
[14]蒋舒玉,吕菁君,魏捷,等.新型布尼亚病毒感染致发热伴血小板减少综合征预后相关性分析[J].中华急诊医学杂志,2015,24(4):380-385.
[15]顾时平,吴雪,周斌,等.浙江省一起发热伴血小板减少综合征聚集性疫情调查[J].中华流行病学杂志,2015,36(4):364-367.
[16]程周祥,王斐,钱帮群,等.皖南地区首起人传聚集性发热伴血小板减少综合征疫情的调查处置[J].中华疾病控制杂志2014,18(11):1055-1058.
[2]Kim KH,Yi J,Kim G,et al.Severe fever with thrombocytopenia syndrome,South Korea,2012[J].Emerg Infect Dis,2013,19(11):1892-1892.
[3]曾庆球,王秋景,张剑静,等.发热伴血小板减少综合征死亡危险因素分析[J].中华传染病杂志,2017,35(6):336-340.
[4]魏艳艳,邹桂舟,叶珺,等.新型布尼亚病毒感染病原学检测与预后研究[J].中华医院感染学杂志,2016,26(23):5339-5341.
[5]马婷.浙江省新型布尼亚病毒感染与死亡危险因素的病例对照研究[D].宁波大学,2016:1-70.
[6]中华人民共和国卫生部.发热伴血小板减少综合征防治指南(2010版)[J].中华临床感染病杂志,2011,4(4):193-194.
[7]中华人民共和国卫生部.发热伴血小板减少综合征诊疗方案[J].中国实用乡村医生杂志,2011,18(5):19-20.
[8]Wang T,Li XL,Liu M,et al.Epidemiological characteristics and environmental risk factors of severe fever with thrombocytopenia syndrome in Hubei province,China,from 2011to2016[J].Front Microbiol,2017,8:387.
[9]徐哲,崔宁,陈威巍,等.422例发热伴血小板减少综合征临床特点分析[J].传染病信息,2015,28(1):28-32.
[10]王建跃,邬辉,仝振东,等.发热伴血小板减少综合征流行病学研究进展[J].中华流行病学杂志,2016,37(2):294-298.
[11]李德新.发热伴血小板减少综合征布尼亚病毒概述[J].中华实验和临床病毒学杂志,2011,25(2):81-84.
[12]陈国胜,胡立芬,许夕海,等.新型布尼亚病毒感染致发热伴血小板减少综合征临床特点及预后影响指标[J].中国医学装备,2017,14(5):94-97.
[13]陈芬芳,陈华忠,林希,等.以肾功能损害为主要表现的新型布尼亚病毒感染患者的临床分析[J].中华传染病杂志,2013,31(3):179-180.
[14]蒋舒玉,吕菁君,魏捷,等.新型布尼亚病毒感染致发热伴血小板减少综合征预后相关性分析[J].中华急诊医学杂志,2015,24(4):380-385.
[15]顾时平,吴雪,周斌,等.浙江省一起发热伴血小板减少综合征聚集性疫情调查[J].中华流行病学杂志,2015,36(4):364-367.
[16]程周祥,王斐,钱帮群,等.皖南地区首起人传聚集性发热伴血小板减少综合征疫情的调查处置[J].中华疾病控制杂志2014,18(11):1055-1058.