Clinical characteristics of 60 children with hemorrhagic fever complicated with renal syndrome and the risk factors of severe cases

doi:10.3877/cma.j.issn.1674-1358.2018.02.010

Abstract

Abstract:

Objective

To investigate the characteristics of clinical data of children with hemorrhagic fever complicated with renal syndrome and the risk factors of severe cases, and to guide the early identification, diagnosis and treatment of the disease.

Methods

Total of 60 patients with hemorrhagic fever complicated with renal syndrome in Xi’an Children’s Hospital from January 2010 to December 2010 were collected. The clinical data were analyzed and the risk factors of severe cases were analyzed by multivariate Logistic regression.

Results

The 60 children all had fever, and the incidence rate of gastrointestinal symptoms was high, but the incidence of typical "three red" and "three pain" in children was not high. In laboratory tests, there were high percentage of abnormal albumin, urine protein, procalcitonin, white blood cells and platelet count in 60 cases. Multivariate Logistic regression analysis showed that PLT < 30 × 10⁹/L (χ² = 34.75, P < 0.001), ALT > 500 U/L (χ² = 27.30, P < 0.001), PCT > 25 ng/ml (χ² = 8.45, P = 0.02), urine protein (χ² = 11.32, P < 0.001), Scr > 250 μmol/L (χ² = 7.89, P < 0.001) were all associated with disease severity, with significant differences.

Conclusions

The clinical manifestations of children hemorrhagic fever complicated with renal syndrome were not typical and specific, so clinicians should be vigilant. PLT, ALT, PCT, Scr and urinary protein were the risk factors of severe HFRS.

Key words: Hemorrhagic fever with renal syndrome, Clinical features, Severe case, Relevant factor

Huiling Deng, Yufeng Zhang, Yuyang Liu, Yu Zhang, Xiaoyan Wang, Jun Wang, Juan Yuan, Pengbo Yu. Clinical characteristics of 60 children with hemorrhagic fever complicated with renal syndrome and the risk factors of severe cases[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(02): 150-154.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsyhlcgrbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-1358.2018.02.010

https://zhsyhlcgrbzz.cma-cmc.com.cn/EN/Y2018/V12/I02/150

Figures/Tables 3

References 24

[1]	余向华, 张孝和, 倪庆翔, 等. 鼠传疾病流行病学研究进展[J]. 中国媒介生物学及控制杂志,2015,26(6):634-636.
[2]	王连魁. 肾综合征出血热临床研究进展[J]. 中华地方病学杂志,2017,36(9):698-702.
[3]	马超锋, 余鹏博, 李恒新, 等. 中国肾综合征出血热流行现状及免疫策略[J]. 中华预防医学杂志,2014(12):1039-1042.
[4]	杨为松主编. 肾综合征出血热[M]. 北京: 人民军医出版社,1999,(9):11-13.
[5]	Jonsson CB, Figueiredo LTM, Vapalahti O. A global perspective on hantavirus ecology, epidemiology, and disease[J]. Clin Microbiol Rev,2010,23(2):412-441.
[6]	Sadeghi M, Eckerle I, Daniel V, et al. Cytokine expression during early and late phase of acute Puumala, hantavirus infection[J]. BMC Immunology,2011,12(1):65.
[7]	邹默,邓璐,张赫男. 肾综合征出血热发病机制的研究现状[J]. 医学综述,2011,17(17):2666-2668.
[8]	王丽娜, 韩增磊, 李晓斐. 肾综合征出血热患者外周血T淋巴细胞亚群的变化及意义[J]. 检验医学,2015,30(1):58-60.
[9]	中华人民共和国卫生部. 流行性出血热防治方案(试行)[J]. 中华传染病杂志,1988,6(3):188-192.
[10]	刘继锋, 相晓妹, 马超锋, 等. 2011-2013年西安市肾综合征出血热流行特征分析[J]. 现代预防医学,2015,42(9):1553-1554.
[11]	赵悦. 儿童流行性出血热36例分析[J]. 中国医师杂志,2010,12(1):97-98.
[12]	吕耀青, 王烨, 杜虹, 等. 儿童肾综合征出血热31例临床分析[J]. 临床医学研究与实践,2017,2(10):95-97.
[13]	马宏炜, 乜铁建, 马永涛, 等. 小儿肾综合征出血热临床特征分析[J]. 中国当代儿科杂志,2014,16(11):1091-1095.
[14]	陈珊莹, 吴彼得, 连学坚, 等. 肾综合征出血热诊治体会[J]. 中国全科医学,2010,13(5):523-524.
[15]	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]. 中国保健营养,2017,27(4):155.
[16]	钟玉, 黄婷. 儿童肾综合征出血热误诊为胃肠炎2例分析[J]. 中国误诊学杂志,2012,12(5):1134-1134.
[17]	Du H, Li J, Yu HT, et al. Early indicators of severity and construction of a risk model for prognosis based upon laboratory parameters in patients with hemorrhagic fever with renal syndrome[J]. Clin Chem Lab Med,2014,52(11):1667-1675.
[18]	Yu Z, Zhou N, Li A, et al. Performance assessment of the SAPS Ⅱ and SOFA scoring systems in Hanta virus hemorrhagic fever with renal syndrome[J]. Int J Infect Dis,2017,63(C)88-94.
[19]	余真君, 赵小瑜, 江挺, 等. 肾综合征出血热重型患者相关因素分析[J]. 浙江预防医学,2017,29(1):73-75.
[20]	涂上卿, 程娜. 肾综合征出血热患者实验室指标变化特点[J]. 临床合理用药杂志,2017,10(5):94-95.
[21]	吴李贤, 叶一农, 白红莲, 等. 佛山地区流行性出血热的临床特点及预后影响因素的研究[J]. 国际医药卫生导报,2014,20(15):2310-2313.
[22]	姜杰, 程春红. 肾综合征出血热合并肝损害72例临床分析[J]. 中国实用医药,2012,7(12):158-159.
[23]	向攀, 赵红心, 王芳, 等. 肾综合征出血热患者降钙素原测定的临床价值[J/CD]. 中华实验和临床感染病杂志:电子版,2015,9(6):28-30.
[24]	Vijayan AL, Vanimaya, Ravindran S, et al. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy[J]. J Intens Care,2017,5(1):51.

项目		例数	构成比（%）
	发热
	有	60	100.00
	无	0	0.00
头痛、眼眶痛、腰痛任一种症状
	有	13	21.67
	无	47	78.33
抽搐
	有	4	6.67
	无	56	93.33
恶心、呕吐
	有	44	73.33
	无	16	26.67
腹痛、腹泻
	有	46	76.67
	无	14	23.33
充血体征
	有	36	60.00
	无	24	40.00
出血体征
	有	35	58.33
	无	25	41.67

项目		例数	构成比（%）
	发热
	有	60	100.00
	无	0	0.00
头痛、眼眶痛、腰痛任一种症状
	有	13	21.67
	无	47	78.33
抽搐
	有	4	6.67
	无	56	93.33
恶心、呕吐
	有	44	73.33
	无	16	26.67
腹痛、腹泻
	有	46	76.67
	无	14	23.33
充血体征
	有	36	60.00
	无	24	40.00
出血体征
	有	35	58.33
	无	25	41.67

项目		例数（例）	构成比（%）
ALT（U/L）
	> 50	25	41.67
	≤ 50	35	58.33
TB（μmol/L）
	> 20	7	11.67
	≤ 20	53	88.33
ALB（g/L）
	< 35	44	73.33
	≥ 35	16	26.67
Cr（μmol/L）
	> 133	29	48.33
	≤ 133	31	51.67
CRP（mg/L）
	> 10	33	55.00
	≤ 10	27	45.00
PCT（ng/ml）
	> 0.1	51	85.00
	≤ 0.1	9	15.00
WBC
	> 12 ×10⁹ /L	46	76.67
	≤ 12 × 10⁹/L	14	23.33
PLT
	< 100 × 10⁹ /L	35	58.33
	≥ 100 × 10⁹ /L	25	41.67
PT（s）
	> 14	20	33.33
	≤ 14	40	66.67
尿隐血
	有	19	31.67
	无	41	68.33
尿蛋白
	有	48	80.00
	无	12	20.00

项目		例数（例）	构成比（%）
ALT（U/L）
	> 50	25	41.67
	≤ 50	35	58.33
TB（μmol/L）
	> 20	7	11.67
	≤ 20	53	88.33
ALB（g/L）
	< 35	44	73.33
	≥ 35	16	26.67
Cr（μmol/L）
	> 133	29	48.33
	≤ 133	31	51.67
CRP（mg/L）
	> 10	33	55.00
	≤ 10	27	45.00
PCT（ng/ml）
	> 0.1	51	85.00
	≤ 0.1	9	15.00
WBC
	> 12 ×10⁹ /L	46	76.67
	≤ 12 × 10⁹/L	14	23.33
PLT
	< 100 × 10⁹ /L	35	58.33
	≥ 100 × 10⁹ /L	25	41.67
PT（s）
	> 14	20	33.33
	≤ 14	40	66.67
尿隐血
	有	19	31.67
	无	41	68.33
尿蛋白
	有	48	80.00
	无	12	20.00

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
PLT < 30 × 10⁹/L	0.88	0.16	34.75	0.00	2.26	1.78~3.32
ALT > 500 U/L	0.49	0.08	27.30	0.00	1.62	1.36~1.95
PCT > 25 ng/ml	1.25	0.15	8.45	0.02	3.35	2.62~4.24
尿蛋白阳性	0.56	0.25	11.32	0.00	1.76	1.28~2.36
Scr > 250 μmol/L	1.98	0.49	7.89	0.00	6.53	1.67~25.19

Please choose a citation manager

Content to export