肾综合征出血热透析危险因素及早期预警价值分析

doi:10.19871/j.cnki.xfcrbzz.2024.03.006

摘要/Abstract

摘要： 目的从临床常用的指标中筛选出肾综合征出血热（hemorrhagic fever with renal syndrome, HFRS）透析危险因素并构建早期预警模型,从而指导临床。方法回顾分析2013年12月至2023年4月在长沙市第一医院感染科住院的112例HFRS患者的病例资料,根据是否进行血液透析分为透析组（38例）与非透析组（74例）,比较两组患者基本资料与常规实验室检查指标的差异,采用Logistic回归构建早期预测模型,使用受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）预警各指标需透析的能力。结果透析组平均住院时间为（24.00±8.95）d,非透析组患者平均住院时间为（16.00±6.10）d;两组性别及基础疾病无差异（均P>0.05）,透析组输血、休克、肺部感染及尿蛋白发生率均高于非透析组,差异有统计学意义（均P<0.05）;透析组年龄低于非透析组（P=0.015）、住院时间长于非透析组（P<0.001）,两组白蛋白（albumin, ALB）水平差异无统计学意义（P=0.393）;白细胞（white blood cell,WBC）计数,降钙素原（procalcitonin, PCT）、肌酐（creatinine,CR）、肌酸激酶同工酶（creatine kinase isoenzymes MB,CK-MB）水平透析组高于非透析组;血小板（platelet, PLT）计数透析组低于非透析组,谷丙转氨酶（glutamic-pyruvic transaminase,ALT）、谷草转氨酶（glutamic oxaloacetic transaminase, AST）、C反应蛋白（c-reactive protein,CRP）及乳酸脱氢酶（lactate dehydrogenase,LDH）则在两组中差异均无统计学意义。年龄、WBC、PLT、PCT、CR、CKMB的AUC分别为0.650、0.712、0.801、0.671、0.700、0.712,预判的最佳阈值分别为48.50岁、11.92×10⁹/L、22.50×10⁹/L、1.63μg/L、181.75μmol/L、25.15U/L;采用Logistic回归制作模型为P=1（1+e-γ),γ=1.745-0.084×PLT+0.006×CR（P为预测患者需要透析的概率值,γ为预测指数）,得出PLT及CR联合检测AUC为0.888,敏感度81.10%,特异度为86.80%。结论年龄、WBC、PLT、PCT、CR、CKMB可作为HFRS患者需行血液透析的早期预测指标,联合指标（PLT、CR）检测较单一指标检测更有助于发现HFRS患者是否需透析。

关键词: 肾综合征出血热, 汉坦病毒, 实验室指标, 透析, 早期预警

Abstract: Objective Screening the dialysis risk factors of hemorrhagic fever with renal syndrome (HFRS) from the commonly used clinical indicators and constructing an early warning model, so as to guide the clinic. Method The clinical data of 112 HFRS patients in the first hospital of Changsha from December 2013 to April 2023 were retrospectively analyzed, divided into dialysis group (38 cases) and non dialysis group (74 cases) based on whether hemodialysis is performed or not. To compare and analyze the differences between the basic data of patients in dialysis group and those in non-dialysis group and the indexes of routine laboratory examination. Logstic regression was used to build an early prediction model, and receiver operating characteristic curve (ROC) was used to warn the dialysis ability of each index. Result In 112 HFRS patients, 38 in dialysis group (33.928%) with (24±8.95) days average hospitalization time and 74 in non-dialysis group (66.07%), and the average hospitalization time was (16±6.10) days. Sex and underlying diseases were no difference in two groups (P>0.05). Blood transfusion, shock, pulmonary infection and proteinuria incidence rates in dialysis group was higher than non-dialysis group, and the differences have significant (P<0.05). Age in dialysis group was less than non-dialysis group(P=0.015） and hospitalization time was longer than non-dialysis group(P<0.001）, and ALB in two groups were no differences (P=0.393). WBC、PCT、CR and CK-MB were higher in dialysis group and PLT was lower in dialysis group. ALT, AST, CRP and LDH were no differences in two groups. The AUC of Age, WBC, PLT, PCT, CR and CKMB is 0.650, 0.712, 0.801, 0.671, 0.700 and 0.712, respectively, and the optimal thresholds for prediction are 48.50 years old, 11.92×10⁹/L, 22.50×10⁹/L,1.63μg/L,181.75μmol/L and 25.15U/L, using Logstic regression model, P=1(1+e-γ), γ=1.745-0.084×PLT+0.006×CR (P is the probability value for predicting patient requiring dialysis, γ is the prediction index), and it is concluded that the AUC of the combined detection of PLT and CR is 0.888, the sensitivity is 81.10%, and the specificity is 86.80%. Conclusion sAge, WBC, PLT, PCT, CR, CKMB can be used as early predictors of whether hemorrhagic fever with renal syndrome needs hemodialysis, and combined indicators (PLT and CR) detection is more helpful to find out whether hemorrhagic fever with renal syndrome needs dialysis than single indicators detection.

Key words: Hemorrhagic fever with renal syndrome, Hantavirus, Laboratory index, Dialysis, Early predict

中图分类号:

R512.8

唐情容, 徐逸洲, 徐春华, 卢瑾, 李向军. 肾综合征出血热透析危险因素及早期预警价值分析[J]. 新发传染病电子杂志, 2024, 9(3): 26-29.

Tang Qingrong, Xu Yizhou, Xu Chunhua, Lu Jin, Li Xiangjun. Analysis of risk factors and early predicting value of dialysis for hemorrhagic fever with renal syndrome[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(3): 26-29.

参考文献

[1] WU J, WANG DD, LI XL, et al.Increasing incidence of hemorrhagic fever with renal syndrome could be associated with livestock husbandry in Changchun, northeastern China[J]. BMC Infect Dis, 2014,14:301.
[2] IANG H, DU H, WANG LM, et al.Hemorrhagic fever with renal syndrome: pathogenesis and clinical picture[J]. Front Cell Infect Microbiol, 2016, 6:1.
[3] SUN L, ZOU L X.Spatiotemporal Analysis And Forecasting Model Of Hemorrhagic Fever With Renal Syndrome In Mainland China[J]. Epidemiol Infect, 2018,146(13):1680-1688.
[4] 中华预防医学会感染性疾病防控分会, 中华医学会感染病学分会. 肾综合征出血热防治专家共识[J]. 中华传染病杂志, 2021, 39(5):257-265.
[5] 李明子, 张旭, 朱白, 等. 血清CYS C测定在肾综合征出血热所致ARF中的意义[J]. 中国实验诊断学, 2009, 13(8):1085-1086.
[6] 蒋涛. 连续性肾脏替代与血液透析治疗流行性出血热疗效时对比观察[J]. 吉林医学,2020,41(3):651-652.
[7] 谢青, 李曾, 李金强, 等. 实验室检查指标在重症肾综合征出血热患者中的早期预警价值分析[J].中华传染病杂志, 2022, 40(5):288-292.
[8] GARANINA E, MARTYNOVA E, DAVIDYUK Y, et al.Cytokine Storm Combined With Humoral Immune Response Defect In Fatal Hemorrhagic Fever With Renal Syndrome Case, Tatarstan, Russia[J]. Viruses, 2019, 11(7):601.
[9] KHAIBOULLINA SF, LEVIS S, MORZUNOV SP,et al.Serum cytokine profiles differentiating hemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome[J]. Front Immunol, 2017,8:567.
[10] 杨晓玲, 王川. 肾综合征出血热患者发生严重急性肾损伤的危险因素多元回归性分析[J]. 临床医学研究与实践, 2021, 6(31): 33-35.
[11] 孟娜娜, 景海宁, 刘国, 等. 肾综合征出血热患者发生严重急性肾损伤的危险因素分析[J]. 西北国防医学杂志, 2019, 40(12):755-760.
[12] 刘兵. 阿魏酸哌嗪对于肾综合征出血热急性肾衰竭患者的影响[J]. 医学理论与实践, 2020, 33(6):927-928.
[13] 薛静. 探讨血常规和尿常规检查在流行性出血热早期诊断中的应用[J]. 临床研究,2017, 2(4):155.
[14] 王晓艳, 杜虹, 李璟, 等. 汉坦病毒感染致血小板减少的机制[J].传染病信息, 2021, 34(1):83-87.
[15] 泽兵,郝钦芳,王莉,等.慢性肾功能不全患者血清同型半胱氨酸与肌酐的相关性分析[J].中国临床医生,2014,42(11):65-67.
[16] FAN X, DENG H, SANG J, et al.High serum procalcitonin concentrations in patients with hemorrhagic fever with renal syndrome caused by hantaan virus[J]. Front Cell Infect Microbiol, 2018, 8(5):129.
[17] GUO J, GUO X, WANG Y, et al.Cytokine response to hantaan virus infection in patients with hemorrhagic fever with renal syndrome[J].J Med Virol, 2017, 89(7):1139-1145
[18] 司志燕,段君君,宋文奇,等. 血清降钙素原与C反应蛋白的医院感染诊断价值[J]. 中国感染控制杂志,2014,13(3):158-160.
[19] 孟娜娜, 景海宁, 刘国, 等.肾综合征出血热患者发生严重急性肾损伤的危险因素分析[J].西北国防医学杂志, 2019, 40(12):755-760.