发热伴血小板减少综合征17例临床诊疗分析

Clinical analysis of 17 cases of severe fever with thrombocytopenia syndrome

关键词:  发热伴血小板减少综合征  临床特点  危险因素

Key words:  severe fever with thrombocytopenia syndrome  clinical features  risk factors

摘要:

目的 探讨发热伴血小板减少综合征（SFTS）患者的临床特征、诊疗方法以及预后影响因素。方法 收集2016年1月至2019年6月大连医科大学附属第二医院收治确诊的17例SFTS患者的流行病学以及临床资料，归纳其临床特点，总结治疗经验及可能导致患者预后不良的因素。结果 17例SFTS患者的发病主要集中在5~9月份，高峰在6~8月份；危重型9例，普通型8例。死亡6例（均为危重型），病死率为35.29%。SFTS患者临床表现多样，以发热、血小板减少及器官功能障碍为主要表现。死亡患者主要为高龄合并有基础病、高热、血小板下降明显者，病程早期出现中枢神经系统症状及合并多器官功能障碍综合征。结论 SFTS患者临床表现多样，对于高龄、血小板迅速下降、存在基础病、存在中枢神经系统症状及合并多器官功能障碍综合征的危重型患者提示病情危重，预后差应高度重视。

Abstract:

Objective To investigate the clinical characteristics, diagnosis, treatment options, and prognostic factors for patients with severe fever complicated by thrombocytopenia syndrome (SFTS). Methods We collected the epidemiology and clinical data of 17 patients with SFTS in Second Affiliated Hospital of Dalian Medical University from January 2016 to June 2019. We summarized the clinical features and analyzed the treatment experience and the factors that may lead to poor prognosis of critically ill patients. Results The onset of the 17 patients was mainly concentrated in May-September with a peak in June-August. Among them, 9 patients were critical type and 8 patients normal type. Six patients (all critical type) died with a fatality rate of 35.29%. The clinical manifestations of the SFTS patients were diverse, with severe fever, thrombocytopenia and organ dysfunction as the main manifestations. The deceased patients were characterized by old age combined with underlying diseases, high fever, severe thrombocytopenia, central nervous system symptoms and multiple organ dysfunctions at early stage of the disease. Conclusions The clinical manifestations of SFTS patients are diverse. The critically ill patients with old age, rapid platelet decline, the presence of underlying diseases, the presence of central nervous system symptoms and multiple organ dysfunctions should be highly regarded due to the critical condition and possible poor prognosis.