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| 发热伴血小板减少综合征胸部CT对临床分型的价值及危重症影响因素 |
| Value of chest CT in clinical classification of patients with sever fever with thrombocytopenia syndrome and risk factors for critical cases |
| 投稿时间：2024-12-16 |
| DOI：10.3969/j.issn.1000-0399.2025.05.004 |
| 中文关键词: 发热伴血小板减少综合征|危重型|计算机体层成像 |
| 英文关键词: Sever fever with thrombocytopenia syndrome|Critical cases|Computed tomography |
| 基金项目:安徽省卫生健康科研项目(编号:AHWJ2022a018) |
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| 中文摘要: |
| 目的 探讨胸部CT对发热伴血小板减少综合征（SFTS）临床分型的价值，并分析SFTS危重症影响因素。方法 选取2018年5月至2024年11月安徽医科大学第一附属医院感染科或急诊科收治的98例SFTS患者为研究对象，根据临床分型分为轻型（7例）、中型（24例）、重型（53例）和危重型（14例），轻、中、重型纳入非危重组（84例）、危重型纳入危重组（14例）。分析4种不同临床分型患者胸部CT表现，比较危重组和非危重组患者不同胸部CT表现的发生率和白细胞（WBC）、血小板（PLT）、活化部分凝血活酶时间（APTT）、血清钾、血清钙、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转氨酶（AST）、血肌酐等临床指标。采用logistic回归分析SFTS危重症影响因素，以受试者工作特征（ROC）曲线评估APTT、AST对SFTS患者危重症发生风险的预测效能。结果 轻型和中型SFTS患者胸部CT主要表现为胸腔积液，双侧胸膜下线增粗、腋窝和/或纵隔淋巴结肿大。重型和危重型患者胸部CT主要表现为肺部感染和肺出血。危重组的肺部感染范围CT评分高于非危重组（P<0.05）。两组患者肺出血、胸膜下线增粗、胸腔积液、腋窝和/或纵隔淋巴结肿大发生率比较，差异无统计学意义（P>0.05）。与非危重组比较，危重组患者的PLT、血清钙减低（P<0.05）,APTT延长（P<0.05）,AST升高（P<0.05）。两组患者WBC、血清钾、ALT和血肌酐的组间比较，差异无统计学意义（P>0.05）。Logistic回归分析结果显示，APTT和AST是危重症SFTS的影响因素（P<0.05）。APTT的ROC曲线分析曲线下面积（AUC）、灵敏度、特异度、最佳截断值分别为0.921、86.71%、84.53%和73.40 s,AST的ROC曲线分析AUC、灵敏度、特异度、最佳截断值分别为0.913、88.81%、79.42%和278.00U/L 。结论 SFTS胸部CT表现越复杂、感染范围越大，提示临床病情越严重。APTT和AST是危重症SFTS的影响因素。 |
| 英文摘要: |
| Objective To explore the value of chest CT in clinical classification in patients with sever fever with thrombocytopenia syndrome（SFTS） and to analyse the risk factors for critical cases. Methods The research recruited 98 patients with SFTS in the Department of Infectious Diseases or the Department of Emergency of the First Hospital of Anhui Medical University. Based on clinical classification, there were 7 mild cases, 24 moderate cases, 53 severe cases, and 14 critical cases. Mild, moderate, and severe cases were included in the noncritical group（84 cases）, while critical cases were in the critical group（14 cases）. We analysed chest CT features of 98 patients according to clinical types. Group comparisons were performed in prevalence of patients’ chest CT features and clinical indicators, including white blood cell（WBC）, platelet（PLT）, activated partial thromboplastine time（APTT）, serum potassium, serum calcium, alanine aminotransferase（ALT）, aspartate aminotransferase（AST） and serum creatinine. Multiple factors regression analysis was used to obtain risk factors of critical cases in patients with SFTS based on indicators with statistically significant inter-group differences. Receiver operating characteristic（ROC） curve was used to assess predictive ability of APTT and AST of the risk of severe cases in SFTS patients. Results The main manifestations of chest CT in mild and moderate cases were parenchymal band, pleural effusion, medistinal/axillary lymphadenopathy, while lung hemorrhage and infection were detected in severe and critical cases. Compared with the non-critical group, patients in critical group showed increased scores on lung infection in chest CT（P＜0.05）. However, there was no group difference in the prevalence of lung hemorrhage, parenchymal band, pleural effusion, medistinal/axillary lymphadenopathy（P＞0.05）. Moreover, patients with SFTS in critical group demonstrated decreased PLT and serum calcium（P＜0.05）, delayed APTT（P＜0.05） and increased AST（P＜0.05）. There was no statistical significant difference in WBC, serum potassium, ALT, and serum creatinine between the two groups（P＞0.05）. Multivariate logistic regression analysis showed that APTT and AST were risk factors for critical cases in SFTS（P＜0.05）. The ROC analysis of APTT showed an area under the curve（AUC） of 0.921, sensitivity of 86.71%, specificity of 84.53%, and optimal cutoff value of 73.40 s. For AST, the ROC analysis yielded an AUC of 0.913, sensitivity of 88.81%, specificity of 79.42%, and optimal cutoff value of 278.00 U/L. Conclusion The more complex in chest CT findings, and the wider spread in lung infection, the more severe the clinical condition. APTT and AST are risk factors for severe SFTS. |
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