摘要
目的探讨实验室检查指标在重症肾综合征出血热(hemorrhagic fever with renal syndrome, HFRS)患者中的早期预警价值。方法收集2013年12月至2020年12月在长沙市第一医院感染科住院的101例HFRS患者的病历资料进行回顾性分析, 比较分析轻症组与重症组各临床常规实验室检查指标的差异。统计学方法采用独立样本t检验、秩和检验、χ^(2)检验、Spearman等级相关分析、logistic回归分析和受试者操作特征曲线。结果 101例HFRS患者中, 重症组38例, 轻症组63例。重症组白细胞计数、天冬氨酸转氨酶(aspartate aminotransferase, AST)、凝血酶原时间(prothrombin time, PT)、肌酸激酶、肌酸激酶同工酶(creatine kinase isoenzyme, CK-MB)、血肌酐、尿素氮和D-二聚体分别高于轻症组, 血小板计数、白蛋白分别低于轻症组, 差异均有统计学意义(t=8.61,Z=-3.76, t=4.19, Z=-2.84、-7.23, t=4.98、4.64、36.02, Z=-5.49, t=4.14;均P<0.050)。重症HFRS与白细胞计数、AST、PT、活化部分凝血活酶时间(activated partial thromboplastin time, APTT)、CK-MB、血肌酐、尿素氮和D-二聚体呈正相关(r=0.629、0.376、0.549、0.471、0.723、0.500、0.341、0.588, 均P<0.001)。白细胞计数、白蛋白、PT和CK-MB是HFRS患者进展为重症的独立影响因子(比值比为0.922、1.374、0.730、0.938, 均P<0.050)。白细胞计数、白蛋白、PT和CK-MB对重症HFRS预警效能的曲线下面积(area under curve, AUC)分别为0.869、0.739、0.785和0.931, 预判的最佳阈值分别为26.38×109/L、26.05 g/L、15.95 s、35.5 U/L, 上述实验室检查指标联合检测的AUC为0.950, 灵敏度为87.3%, 特异度为94.7%。结论白细胞计数、白蛋白、PT和CK-MB可作为早期预警重症HFRS的独立影响因子, 联合指标检测较单一指标检测更有助于重症HFRS的早期预警。
Objective To explore the early warning value of laboratory parameters in patients with severe hemorrhagic fever with renal syndrome(HFRS).Methods The clinical data of 101 patients with HFRS hospitalized in the Department of Infectious Diseases of the First Hospital of Changsha from December 2013 to December 2020 were collected and analyzed.The differences of clinical routine laboratory parameters between mild and severe HFRS patients were compared and analyzed.The statistical methods including independent sample t test,rank sum test,chi-square test,Spearman rank correlation analysis,logistic regression analysis and receiver operator characteristic curve were used.Results Among 101 patients with HFRS,38 cases were in severe group and 63 cases in mild group.White blood cell count,aspartate aminotransferase(AST),prothrombin time(PT),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),serum creatinine,urea nitrogen and D-dimer in severe group were higher than those in mild group,while platelet count and albumin were lower than those in mild group,and the differences were all statistically significant(t=8.61,Z=-3.76,t=4.19,Z=-2.84,Z=-7.23,t=4.98,t=4.64,t=36.02,Z=-5.49 and t=4.14,respectively;all P<0.050).Severe HFRS was positively correlated with white blood cell count,AST,PT,activated partial thromboplastin time(APTT),CK-MB,serum creatinine,urea nitrogen and D-dimer(r=0.629,0.376,0.549,0.471,0.723,0.500,0.341 and 0.588,respectively;all P<0.001).White blood cell count,albumin,PT and CK-MB were independent influencing factors for the progression of severe HFRS(odds ratio(OR)=0.922,1.374,0.730 and 0.938,respectively;all P<0.050).The area under curve(AUC)of white blood cell count,albumin,PT and CK-MB for the early warning prediction of severe HFRS were 0.869,0.739,0.785 and 0.931,respectively,with the optimal thresholds for prediction of 26.38×109/L,26.05 g/L,15.95 s and 35.5 U/L,respectively.And the AUC of the combined detection of the above laboratory parameters was 0.950,with the sensitivity of 87.3%and the specificity of 94.7%.Conclusions White blood cell count,albumin,PT and CK-MB could be used as independent influencing factors for early warning of severe HFRS.Combined detection is more helpful for early warning of severe HFRS than single detection.
作者
谢青
李曾
李金强
刘凤娥
Xie Qing;Li Zeng;Li Jinqiang;Liu Feng′e(Department of Infectious Diseases,The First Hospital of Changsha,Changsha 410000,China)
出处
《中华传染病杂志》
CAS
CSCD
2022年第5期288-292,共5页
Chinese Journal of Infectious Diseases
基金
长沙市级医学重点学(专)科建设项目(2020110)。
关键词
肾综合征出血热
实验室检查指标
重症
早期预警
Hemorrhagic fever with renal syndrome
Laboratory parameters
Severe
Early warning value
