摘要
目的了解2017年至2019年肾综合征出血热患者的流行病学和临床特征。方法纳入2017年1月1日至2019年12月31日于安徽医科大学第一附属医院感染病科住院治疗的75例肾综合征出血热患者,回顾性分析患者的流行病学、临床症状、血常规、尿常规、血肌酐、肝功能等实验室检查指标。呈偏态分布的计量资料以M(QR)表示,比较采用非参数检验。采用多因素logistic回归分析疾病相关危险因素。结果75例患者起病时所在地区主要集中在安徽省西部和北部区域,高发期为每年11月份、12月份和次年1月份,共37例(49.3%)。54例(72.0%)患者为农民,10例(13.3%)患者有明确的鼠类接触史,仅19例(25.3%)患者出现典型"三红三痛"表现。58例(77.3%)患者出现白细胞计数升高,67例(89.3%)血小板计数减少,尿蛋白+++者55例(73.3%),尿隐血者65例(86.7%),67例(89.3%)血肌酐升高。31例重型和危重型患者的血肌酐值、血钾水平分别为495(301)μmol/L和4.14(0.77)mmol/L,均高于44例轻型和中型患者的235(289)μmol/L和3.65(1.02)mmol/L,差异均有统计学意义(Z=-3.187、-2.796,均P<0.01)。多因素logistic回归分析显示,血肌酐[比值比(odds ratio,OR)=1.005,95%可信区间1.002~1.008]和血钾(OR=2.632,95%可信区间1.098~6.313)为疾病重症化的独立危险因素。所有患者予以内科综合治疗,27例患者接受肾脏替代治疗。68例患者预后良好,4例死亡。结论肾综合征出血热在冬春季节的农村仍较常见,临床表现常不典型且重型和危重型患者较多,临床诊治应予以密切关注。
Objective To investigate the epidemiological and clinical features of patients with hemorrhagic fever with renal syndrome(HFRS)from 2017 to 2019.Methods Seventy-five patients with HFRS from the Department of Infectious Diseases,The First Affiliated Hospital of Anhui Medical University during January 1,2017 to December 31,2019 were included.The data of epidemiology,clinical symptoms,blood routine,urine routine,serum creatinine,liver function and other laboratory examination indexes were retrospectively analyzed.The measurement data with skewness distribution were expressed by M(QR)and compared by nonparametric test.Multivariate logistic regression analysis was used to analyze disease-related risk factors.Results The 75 patients were mainly located in the western and northern regions of Anhui Province.A total of 37 cases(49.3%)were infected during November,December and January next year.Fifty-four(72.0%)patients were farmers and 10(13.3%)patients had a clear history of rodent contact.Only 19(25.3%)patients had typical clinical manifestations of"three red and three pain".Fifty-eight(77.3%)patients had elevated white blood cell count,67(89.3%)patients had decreased platelet count,55(73.3%)patients had urinary protein+++,65(86.7%)patients had abnormal urinary occult blood,and 67(89.3%)patients had elevated serum creatinine.The serum creatinine and potassium levels in 31 severe and critical patients were 495(301)μmol/L and 4.14(0.77)mmol/L,respectively,which were both higher than those in 44 mild and moderate patients(235(289)μmol/L and 3.65(1.02)mmol/L,respectively).The differences were both statistically significant(Z=-3.187 and-2.796,respectively,both P<0.01).Multivariate logistic regression analysis showed that serum creatinine(odds ratio(OR)=1.005,95%confidence interval(CI)1.002-1.008)and serum potassium(OR=2.632,95%CI 1.098-6.313)were independent risk factors for disease severity.All patients received comprehensive medical treatment,and 27 patients received renal replacement therapy.Sixty-eight patients had good prognosis and four patients died.Conclusions HFRS is still common in the rural area in winter and spring.Patients with atypical clinical manifestations and severe and critical patients should be intensively monitored.
作者
程君
李江
卞婷婷
薛继华
马雪娇
李家斌
Cheng Jun;Li Jiang;Bian Tingting;Xue Jihua;Ma Xuejiao;Li Jiabin(Department of Infectious Diseases,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《中华传染病杂志》
CAS
CSCD
2021年第4期204-208,共5页
Chinese Journal of Infectious Diseases
基金
国家科技重大专项(2017ZX10204401-002-006)。
关键词
肾综合征出血热
流行病学
临床特征
Hemorrhagic fever with renal syndrome
Epidemiology
Clinical characteristics
