101例发热伴血小板减少综合症确诊病例的流行病学和临床特征分析
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摘要
目的探讨发热伴血小板减少综合征(Severe Fever with Thrombocytopenia Syndrome,SFTS)流行病学及临床特征。方法采用统一的诊断标准和流行病学个案调查表对病例进行调查。结果 2011-2014年威海市立医院共报告101例确诊病例,死亡8例,病死率7.92%。病例年龄中位数为62岁(范围为33~82岁),男女性别比为0.87(47∶54);农民占全部病例的74.25%(75/101);病例主要集中在6-8月份,占74.25%(75/101);9.90%(10/101)病例有明确蜱虫叮咬史,3.96%(4/101)病例与患者有密切接触史。临床表现主要有发热(100%)、乏力(77.52%)、精神不振(51.69%)、恶心(47.19%)、腹泻(41.57%)等症状;实验室检查WBC、PLT降低,ALT、AST、LDH、CK、肌酸激酶同工酶、a-羟丁酸脱氢酶升高。结论病例多发生在夏季,呈散在发生,以中老年为主,职业以农民为主。临床表现以发热伴白细胞、血小板减少和多脏器功能损害为主。60岁以上病例病情较重。
Objective This work was to investigate and analyze the epidemiological characteristics of severe fever with thrombocytopenia syndrome(SFTS). Methods The uniform diagnosis standard and questionnaire were used to collect the information of cases diagnosed in Shandong province, 2010. Results Among the total of 101 cases, the mortality was 7.92%.The age of patients ranged from 33 to 82 years old with the median age of 62. Sex ratio(male:female) was 0.87 ∶1. Among the patients, 74.25% were farmers. The incidence peaked from June to August. Investigations indicate 9.90%(10/101)of patients have been biten by ticks and 3.96% had a history of contact with patients. The major clinical symptoms were fever, fatigue,lassitude, nausea, diarrhea etc. The most common laboratory finding of this disease was decrease in the number of platelets and white blood cells, and increase in ALT, AST, LDH, CK, MBI, XHBD. Conclusion Thrombocytopenia peaked in summer,and scattered in places. Most patients were older people and farmers. Most patients have a moderately severe thrombocytopenia, leukocytopenia and organ failure. The cases occurred to the elderly over 60 were serious.
Objective This work was to investigate and analyze the epidemiological characteristics of severe fever with thrombocytopenia syndrome(SFTS). Methods The uniform diagnosis standard and questionnaire were used to collect the information of cases diagnosed in Shandong province, 2010. Results Among the total of 101 cases, the mortality was 7.92%.The age of patients ranged from 33 to 82 years old with the median age of 62. Sex ratio(male:female) was 0.87 ∶1. Among the patients, 74.25% were farmers. The incidence peaked from June to August. Investigations indicate 9.90%(10/101)of patients have been biten by ticks and 3.96% had a history of contact with patients. The major clinical symptoms were fever, fatigue,lassitude, nausea, diarrhea etc. The most common laboratory finding of this disease was decrease in the number of platelets and white blood cells, and increase in ALT, AST, LDH, CK, MBI, XHBD. Conclusion Thrombocytopenia peaked in summer,and scattered in places. Most patients were older people and farmers. Most patients have a moderately severe thrombocytopenia, leukocytopenia and organ failure. The cases occurred to the elderly over 60 were serious.
引文
[1]中华人民共和国卫生部.卫生部办公厅关于印发《发热伴血小板减少综合征防治指南(2010版)》的通知[EB/OL].(2010-10-08).http://www.nhfpc.gov.cn/Mohwsyjbgs/s8348/201010/49272.shtml.
[2]Yu XJ,Liang MF,Zhang SY,et al.Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China[J].New England Journal of Medicine,2011,364(16):1523-1532.
[3]王玲,曹海霞,崔峰,等.淄博市发热伴血小板减少综合征监测分析[J].现代预防医学,2013(18):3471-3474.
[4]邬辉,王建跃,仝振东,等.浙江省舟山市2011-2013年发热伴血小板减少综合征流行特征分析[J].中华流行病学杂志,2014,35(12):1371-1374.
[5]叶继斌,胡传松,陈远山,等.发热伴血小板减少综合征临床观察--附22例病例分析[J].中华实验和临床感染病杂志:电子版,2012,6(3):249-250.
[6]陶文元,陶欣.新型布尼亚病毒感染致发热伴血小板减少综合征8例报告[J].江苏大学学报:医学版,2011,21(1):91-92.
[7]Liu Y,Li Q,Hu W,et al.Person-to-p erson transmission of severe fever with thrombocytopenia syndrome virus[J].Vector borne and zoonotic diseases(Larchmont,N.Y.),2012,12(2):156-160.
[8]Wang Y,Deng B,Zhang J,et al.Person-to-person asymptomatic infection of severe fever with thrombocytopenia syndrome virus through blood contact[J].Internal medicine(Tokyo,Japan),2014,53(8):903-906.
[9]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.
[10]滕海风,李爱君,徐宁,等.家庭内同患新型布尼亚病毒感染四例临床分析[J].中国全科医学,2012,15(13):1529-1530.
[11]Liu Q,He B,Huang SY,et al.Severe fever with syndrome,thrombocytopenia an emerging tick-borne zoonosis[J].The Lancet infectious diseases,2014,14(8):763-772.
[12]李昱,周航,牟笛,等.中国2011-2014年发热伴血小板减少综合征流行特征分析[J].中华流行病学杂志,2015,36(6):598-602.
[2]Yu XJ,Liang MF,Zhang SY,et al.Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China[J].New England Journal of Medicine,2011,364(16):1523-1532.
[3]王玲,曹海霞,崔峰,等.淄博市发热伴血小板减少综合征监测分析[J].现代预防医学,2013(18):3471-3474.
[4]邬辉,王建跃,仝振东,等.浙江省舟山市2011-2013年发热伴血小板减少综合征流行特征分析[J].中华流行病学杂志,2014,35(12):1371-1374.
[5]叶继斌,胡传松,陈远山,等.发热伴血小板减少综合征临床观察--附22例病例分析[J].中华实验和临床感染病杂志:电子版,2012,6(3):249-250.
[6]陶文元,陶欣.新型布尼亚病毒感染致发热伴血小板减少综合征8例报告[J].江苏大学学报:医学版,2011,21(1):91-92.
[7]Liu Y,Li Q,Hu W,et al.Person-to-p erson transmission of severe fever with thrombocytopenia syndrome virus[J].Vector borne and zoonotic diseases(Larchmont,N.Y.),2012,12(2):156-160.
[8]Wang Y,Deng B,Zhang J,et al.Person-to-person asymptomatic infection of severe fever with thrombocytopenia syndrome virus through blood contact[J].Internal medicine(Tokyo,Japan),2014,53(8):903-906.
[9]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.
[10]滕海风,李爱君,徐宁,等.家庭内同患新型布尼亚病毒感染四例临床分析[J].中国全科医学,2012,15(13):1529-1530.
[11]Liu Q,He B,Huang SY,et al.Severe fever with syndrome,thrombocytopenia an emerging tick-borne zoonosis[J].The Lancet infectious diseases,2014,14(8):763-772.
[12]李昱,周航,牟笛,等.中国2011-2014年发热伴血小板减少综合征流行特征分析[J].中华流行病学杂志,2015,36(6):598-602.