CAJ | 학술논문

目的：探讨发热伴血小板减少综合征（SFTS）死亡相关因素，设立 SFTS 危重度评分并检验其对 SFTS 患者预后的评价作用。方法对2011年6月至2014年10月山东大学附属济南市传染病医院住院治疗并确诊为 SFTS 的123例患者行死亡相关危险因素的 Logistic 回归分析，进而设定 SFTS危重度评分，并通过受试者工作特征曲线（ROC）与快速急诊内科评分（REMS 评分）、急性生理和慢性健康评分系统Ⅱ（APACHEⅡ）进行预后预测能力的比较。结果123例患者中死亡31例（死亡组），男17例，女14例；生存92例（生存组），男45例，女47例。单因素 Logistic 回归分析结果显示，格拉斯哥昏迷（GCS）评分、乳酸脱氢酶、部分活化凝血活酶时间、脉搏血氧饱和度与 SFTS 死亡相关，差异均有统计学意义（均 P ＜0．05）。且4项指标的单项评分，死亡组均高于存活组（均 P ＜0．05）。SFTS 死亡组的REMS、APACHEⅡ评分和 SFTS 危重度评分均高于存活组（均 P ＜0．01）。REMS、APACHEⅡ评分和SFTS 危重度评分的曲线下面积（AUC）分别为0．734、0．746、0．788。Youden 指数以 SFTS 危重度评分为最高，当取阈值为15．0时，其预测 SFTS 患者住院期间死亡风险的敏感度为74．2％，特异度为76．1％。结论 REMS、APACHEⅡ评分和 SFTS 危重度评分对 SFTS 预后均具有良好的评价作用，其中以 SFTS 危重度评分更为简捷且预测能力最佳。
목적：탐토발열반혈소판감소종합정（SFTS）사망상관인소，설립 SFTS 위중도평분병검험기대 SFTS 환자예후적평개작용。방법대2011년6월지2014년10월산동대학부속제남시전염병의원주원치료병학진위 SFTS 적123례환자행사망상관위험인소적 Logistic 회귀분석，진이설정 SFTS위중도평분，병통과수시자공작특정곡선（ROC）여쾌속급진내과평분（REMS 평분）、급성생리화만성건강평분계통Ⅱ（APACHEⅡ）진행예후예측능력적비교。결과123례환자중사망31례（사망조），남17례，녀14례；생존92례（생존조），남45례，녀47례。단인소 Logistic 회귀분석결과현시，격랍사가혼미（GCS）평분、유산탈경매、부분활화응혈활매시간、맥박혈양포화도여 SFTS 사망상관，차이균유통계학의의（균 P ＜0．05）。차4항지표적단항평분，사망조균고우존활조（균 P ＜0．05）。SFTS 사망조적REMS、APACHEⅡ평분화 SFTS 위중도평분균고우존활조（균 P ＜0．01）。REMS、APACHEⅡ평분화SFTS 위중도평분적곡선하면적（AUC）분별위0．734、0．746、0．788。Youden 지수이 SFTS 위중도평분위최고，당취역치위15．0시，기예측 SFTS 환자주원기간사망풍험적민감도위74．2％，특이도위76．1％。결론 REMS、APACHEⅡ평분화 SFTS 위중도평분대 SFTS 예후균구유량호적평개작용，기중이 SFTS 위중도평분경위간첩차예측능력최가。
Objective To investigate of the risk factors for the death of severe fever with thrombocytopenia syndrome (SFTS),so as to set up SFTS critical score and evaluate its role in predicting the prognosis for patients with SFTS.Methods A total of 123 SFTS patients hospitalized in Ji′nan Hospital of Infectious Diseases affiliated to Shandong University from June 2011 to October 2014 were enrolled in this study.The univariate Logistic regression analysis was performed to analysis the risk factor for the death of SFTS.Then the SFTS critical score system was set up accordingly.The prognosis value of SFTS critical score was compared with the rapid emergency medicine score (REMS)and the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ)by using receiver operator characteristic curve (ROC).Results Among all the patients,17 males and 14 females were in death group,and 45 males and 47 females were in survival group.The results of the univariate Logistic regression analyses indicated that the glasgow coma scale (GCS),lactate dehydrogenase,activated partial thromboplastin time,oxygen saturation were risk factors for the death of SFTS,with statistically significant difference (all P <0.05). All of the four parameters of SFTS critical scores in the death group were higher than those in the survival group,with statistically significant difference (all P <0.05 ).The REMS,APACHEⅡ score and SFTS critical score in the death group were significantly higher than those in the survival group (all P <0.01 ). The area under the curve (AUC)of REMS,APACHE Ⅱ scores and SFTS critical score were 0.734, 0.746 and 0.788,respectively.The Youden index of the SFTS critical scores was the highest among all three scores (P <0.01).If 15 .0 was used as the cut off value of SFTS critical score,the specificity and the sensitivity for predicting the death risk for the hospitalized patient were 74.2% and 76.1 %, respectively.Conclusion SFTS critical score,REMS and APACHEⅡ score can all effectively predict the prognosis for SFTS patients,among which,the SFTS critical score is the most convenient and has the best predictive value.