发热伴血小板减少综合征的临床特征及对细胞因子的影响

Clinical Feature of Severe Fever with Thrombocytopenia Syndrome and the Effect on Cytokine

摘要: 目的：通过描述性研究，初步探讨发热伴血小板减少综合征流行病学、临床特征、独立危险因素对细胞因子的影响。方法：选取发热伴血小板减少综合征病例及疑似病例162例，死亡21例，作为死亡组，剩余141例作为存活组，同时选取正常成人30例作为对照组。采集血清标本送检，观察患者流行病学及临床资料，以及血清生化学、CRP、TNF-α和IL-6等的水平。计量资料以x ± s或中位数(最小值~最大值)表示，采用独立样本t检验，计数资料以例数与百分率表示，行X2检验，P < 0.05为差异有统计学意义。对疾病影响因素进行条件Logistic回归分析。结果：Logistic多因素回归分析，发热程度、严重消化道症状、神经系统症状、出血倾向、白细胞计数等因素与病死独立相关，OR值在3.69~7.52之间，P值均<0.05。所有患者及对照组均检测血清CRP、IL-6、TNF-α水平，所有发热伴血小板减少综合征患者血清CRP、IL-6、TNF-α水平高于正常对照组，有统计学差异；而死亡组与存活组比较，死亡组血清CRP、IL-6、TNF-α水平高于存活组，两者有显著性差异。结论：发热程度、严重消化道症状、神经系统症状、出血倾向、白细胞计数等因素是疾病死亡的危险因素。CRP、IL-6、TNF-α三种细胞因子在发病机制中可能起重要作用。

Abstract: Objective: Through descriptive research, preliminary discusses the epidemiology, clinical charac-teristics, independent risk factors of severe fever with thrombocytopenia syndrome (SFTS), and the effect on cytokine. Methods: Select 162 severe fever with thrombocytopenia syndrome cases and suspected cases; 21 cases of death, as the group of death, the remaining 141 cases as the survival group. At the same time, 30 normal adults were selected as control group. Serum specimens were collected, epidemiological and clinical data and the level of serum biochemistry, CRP, TNF-α and IL-6 etc. were observed. Metrological data are expressed as x + s or median (minimum to maximum), using the independent sample t test, counting data are expressed by examples and percentages, using X2 test, P < 0.05, the difference is significant, using conditional logistic regression analysis of influencing factors of disease. Results: Of multiple logistic regression analysis, the degree of fever, severe gastrointestinal symptoms, neurological symptoms, bleeding tendency, white blood cell count and other factors independently related to mortality; the OR value was between 3.69 - 7.52, P < 0.05. Serum CRP, IL-6, TNF-α levels of all patients were measured in all patients and control group. The serum levels of CRP, IL-6 and TNF-α in all patients with fever and thrombocytopenia syndrome were higher than those in the control group, with statistical difference. And the death group was compared with the survival group. The serum levels of CRP, IL-6 and TNF-α in the death group were higher than those in the survival group, and there were significant differences between the two groups. Conclusion: The degree of fever, severe gastrointestinal symptoms, neurological symptoms, bleeding tendency, white blood cell count were risk factors for death. CRP, IL-6, TNF-α three cytokines may play an important role in the pathogenesis.