重症发热伴血小板减少综合征患者死亡危险因素及预测模型研究

杨云; 王晓芳; 梅清; 燕宪亮

doi:10.16766/j.cnki.issn.1674-4152.004283

重症发热伴血小板减少综合征患者死亡危险因素及预测模型研究

doi: 10.16766/j.cnki.issn.1674-4152.004283

杨云¹,
王晓芳³,
梅清⁴,
燕宪亮^1, ,

1.
徐州医科大学第二临床医学院，江苏徐州 221004
2.
中国科学技术大学附属第一医院(安徽省立医院)感染科, 安徽合肥 230001
3.
中国科学技术大学附属第一医院(安徽省立医院)检验科
4.
中国科学技术大学附属第一医院(安徽省立医院)重症医学科

基金项目:

国家重点研发计划子课题 2020YFC1512704

江苏省科技厅基础研究计划自然科学基金面上项目 BK20231162

安徽省卫生健康科研项目 AHWJ2023A30265

详细信息

通讯作者:
燕宪亮，E-mail: docyxl@163.com

中图分类号: R558.2 R730.7
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- 文章访问数: 8
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- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-10-26
- 网络出版日期: 2026-03-13

Research on risk factors for mortality and a predictive model for severe fever with thrombocytopenia syndrome

1.
The Second Clinical Medical School, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China

摘要

摘要: 目的研究重症发热伴血小板减少综合征(SFTS)患者死亡的危险因素，建立风险预测模型，以期为重症SFTS的预后判断提供依据。方法回顾分析2023年1—12月中国科学技术大学附属第一医院(安徽省立医院)感染科收治的30例重症SFTS患者，根据预后分为存活组(15例)和死亡组(15例)，对2组的临床资料进行分析。结果选择热程≥7 d(a)、是否昏迷(b)、活化部分凝血活酶时间(APTT, c)、天冬氨酸转氨酶(AST，d)、肌酸激酶(CK, e)、白细胞介素-6(IL-6, f)、单核细胞(MONO，g)，通过Fisher判别分析建立预测死亡(X)函数为：X=-23.731+2.632a+18.146b+0.425c-0.009d+0.002f+0.650g；预测存活(Y)函数为：Y=-16.245-4.594a-0.416b+0.491c-0.015d-0.001e+0.002f+16.057g；得到判别函数值，预测死亡(X)风险模型判别正确率为93.3%，预测存活(Y)概率模型正确率为100.0%，整体预测准确率为96.7%。结论重症SFTS患者多数为老年人，具有较高的死亡率，基于热程≥7 d、昏迷、APTT、AST、CK、IL-6、MONO建立的死亡预测模型准确率高，有预测价值。
- 发热伴血小板减少综合征 /
- 死亡危险因素 /
- 预测模型
Abstract: Objective To investigate risk factors associated with mortality in patients with severe fever with thrombocytopenia syndrome (SFTS) and to establish a mortality risk prediction model, with the aim of providing evidence for therapeutic decision-making and prognosis judgement of SFTS. Methods A retrospective analysis was conducted on 30 patients with severe SFTS admitted to the Department of Infectious Disease of the First Affiliated Hospital of USTC (Anhui Provincial Hospital) from January to December 2023. The patients were divided into a survival group (n=15) and the death group (n=15) based on their outcomes. Clinical characteristics and laboratory indicators from the two groups were compared. Results Seven variables were selected for further analysis: fever duration ≥ 7 days (a), coma (b), activated partial thromboplastin time (APTT, c), aspartate aminotransferase (AST, d), creatine kinase (CK, e), interleukin-6 (IL-6, f), and monocyte count (MONO, g). The Fisher discriminant analysis was used to establish a predictive death (X) function as follows: X=-23.731+2.66a+18.146b+0.425c-0.009d+0.002f+0.650g, and a predicted survival (Y) function: Y=-16.245-4.594a-0.416b+0.491c-0.015d-0.001e+0.002f+16.057g. The discriminant function values showed that the mortality (X) prediction model had an accuracy of 93.3%, the survival (Y) probability model had an accuracy of 100.0%, and the overall prediction accuracy was 96.7%. Conclusion Severe SFTS is associated with high mortality. The mortality prediction model based on fever duration≥7 days, coma, APTT, AST, CK, IL-6, and MONO demonstrates high accuracy and possesses significant predictive value.
- Severe fever with thrombocytopenia syndrome /
- Risk factors for mortality /
- Prediction model

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表 1 2组SFTS患者基线特征比较

Table 1. Comparison of baseline characteristics between the two groups of SFTS patients

组别	例数	年龄(x±s，岁)	性别(男性/女性，例)	发病到确诊时间[M(P₂₅, P₇₅)，d]	发病到入住ICU时间(x±s，d)	总住院时间[M(P₂₅, P₇₅)，d]	≥2个基础疾病[例(%)]	高血压[例(%)]	糖尿病[例(%)]	脑卒中[例(%)]
存活组	15	64.93±13.80	11/4	7(4, 9)	8.13±2.62	16(13, 20)	5(33.33)	7(46.67)	1(6.67)	3(20.00)
死亡组	15	72.40±7.12	9/6	6(4, 8)	8.20±2.21	5(2, 7)	5(33.33)	6(40.00)	3(20.00)	4(26.67)
统计量		1.863^a		-0.912^c	0.075^a	-4.455^c
P值		0.077	0.700^b	0.362	0.940	＜0.001	0.999^b	0.598^b	0.999^b	0.999^b
注：^a为t值，^b为采用Fisher精确检验，^c为Z值。

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表 2 2组SFTS患者临床症状比较[例(%)]

Table 2. Comparison of clinical manifestations between the two groups of SFTS patients

项目	例数	存活组(n=15)	死亡组(n=15)	P值^a
发热≥7 d	16	4(26.67)	12(80.00)	0.001
呼吸系统症状	19	6(40.00)	13(86.67)	0.002
神经系统症状	25	10(66.67)	15(100.00)	0.100
昏迷	16	1(6.67)	15(100.00)	＜0.001
皮肤黏膜出血	19	4(26.67)	15(100.00)	＜0.001
胃肠道出血	8	4(26.67)	4(26.67)	0.450
心律失常	26	13(86.67)	13(86.67)	0.999
休克	10	2(13.33)	8(53.33)	0.050
心功能不全	15	6(40.00)	9(60.00)	0.466
注：^a为采用Fisher精确检验。

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表 3 2组SFTS患者治疗方式比较[例(%)]

Table 3. Comparison of treatments between the two groups of SFTS patients [cases (%)]

组别	例数	皮质类固醇	丙球蛋白	升压剂	需要呼吸支持	CRRT
存活组	15	14(93.33)	14(93.33)	2(13.33)	4(26.67)	1(6.67)
死亡组	15	13(86.67)	15(100.00)	10(66.67)	15(100.00)	6(40.00)
P值^a		0.999	0.999	0.008	＜0.001	0.080
注：^a为采用Fisher精确检验。

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表 4 2组SFTS患者实验室检查指标比较

Table 4. Comparison of laboratory examinations between the two groups of SFTS patients

项目	存活组(n=15)	死亡组(n=15)	统计量	P值
WBC[M(P₂₅, P₇₅), ×10⁹/L]	1.80(1.17, 6.20)	2.0(1.55, 3.33)	-0.228^a	0.820
NE[M(P₂₅, P₇₅), ×10⁹/L]	3.28(1.10, 6.32)	1.43(0.80, 2.56)	-0.933^a	0.351
L(x±s, ×10⁹/L)	0.65±0.28	0.62±0.32	0.266^b	0.792
N/L[M(P₂₅, P₇₅)]	5.64(2.52, 8.87)	3.18(1.46, 4.32)	0.850^a	0.395
MONO[M(P₂₅, P₇₅), ×10⁹/L]	0.57(0.28, 0.88)	0.08(0.05，0.20)	-3.342^a	0.001
PLT[M(P₂₅, P₇₅), ×10⁹/L]	22(11, 28)	24(12, 28)	-0.312^a	0.755
AST[M(P₂₅, P₇₅), U/L]	217(96, 406)	576(356, 1104)	-2.821^a	0.005
LDH[M(P₂₅, P₇₅), U/L]	1 249(569, 1 899)	2 507(1 299, 3192)	-2.883^a	0.004
CK[M(P₂₅, P₇₅), U/L]	565(290, 1 243)	3 537(1 210, 5 181)	-3.443^a	< 0.001
APTT[M(P₂₅, P₇₅), s]	53.00(44.40, 66.90)	74.00(64.00, 80.00)	-2.884^a	0.004
CRP[M(P₂₅, P₇₅), mg/L]	23.68(10.30, 49.65)	28.32(8.37, 65.00)	-0.311^a	0.756
SF[M(P₂₅, P₇₅), μg/mL]	2 944(2 109, 3 124)	2 201(1 636, 2 837)	-1.421^a	0.155
IL-6 [M(P₂₅, P₇₅), pg/mL]	18.6(6.5, 34.1)	124.0(69.0, 304.0)	-3.878^a	< 0.001
核酸阳性[例(%)]	15(50.00)	14(46.67)		0.999^c
核酸Ct值(x±s)	23.90±2.94	21.36±4.84	1.720^b	0.097
注：^a为Z值，^b为t值，^c为采用Fisher精确检验。

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表 5 Fisher判别分析预测SFTS患者临床结局

Table 5. Fisher discriminate analysis predict the accuracy of SFTS patient outcomes

结局指标	好转[例(%)]	死亡[例(%)]	总计(例)
好转	14(93.30)	1(6.70)	15
死亡	0	15(100.00)	15

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