发热伴血小板减少综合征与肾综合征出血热的诊断与鉴别诊断的研究进展

doi:10.3969/j.issn.1674-8115.2023.11.015

摘要/Abstract

摘要：

发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome，SFTS）和肾综合征出血热（hemorrhagic fever with renal syndrome，HFRS）均为传染性疾病。该2种疾病的流行可严重影响人类的生命健康，也是当前全球面临的公共卫生问题。由于世界各地医学发展水平参差不齐，很多医师对该2种疾病的诊断及鉴别诊断能力不足，易造成漏诊或误诊，致使患者得不到恰当的救治而加重病情，最终影响患者预后。临床上，SFTS和HFRS的诊断主要分别依赖于病原学检查、血清学检查的结果，但目前较多的医疗机构尚未开展该2种检查。因此，若能借助流行病学特征、临床特征对该2种疾病开展诊断和鉴别诊断，将有助于指导临床实践。该文就近年来国内外对SFTS及HFRS在诊断与鉴别诊断方面的研究进展进行综述。

关键词: 发热伴血小板减少综合征, 肾综合征出血热, 诊断, 鉴别诊断

Abstract:

Severe fever with thrombocytopenia syndrome (SFTS) and hemorrhagic fever with renal syndrome (HFRS) are infectious diseases. The epidemic of these two diseases can seriously affect human life and health, and is also a public health problem currently facing in the world. Due to the uneven level of medical development around the world, many doctors have insufficient understanding of these two diseases, which is likely to lead to missed diagnosis or misdiagnosis, and the patients are not treated correctly, which leads to aggravation of the disease and affects their prognosis. Clinically, the diagnosis of SFTS and HFRS mainly depends on the results of pathogenic examination and serological examination, but many medical institutions have not carried out these two examinations. Therefore, if epidemiological and clinical characteristics can be used to diagnose and differentiate these two diseases, it will help guide clinical practice. This paper reviews the research progress in the diagnosis and differential diagnosis of SFTS and HFRS at home and abroad in recent years.

Key words: severe fever with thrombocytopenia syndrome (SFTS), hemorrhagic fever with renal syndrome (HFRS), diagnosis, differential diagnosis

中图分类号:

R511

闫文月, 李强. 发热伴血小板减少综合征与肾综合征出血热的诊断与鉴别诊断的研究进展[J]. 上海交通大学学报（医学版）, 2023, 43(11): 1457-1462.

YAN Wenyue, LI Qiang. Research progress in diagnosis and differential diagnosis of severe fever with thrombocytopenia syndrome and hemorrhagic fever with renal syndrome[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(11): 1457-1462.

图/表 2

参考文献 30

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Clinical symptom/sign	SFTS patient		HFRS patient
Clinical symptom/sign	Overall number of people	n (%)	Overall number of people	n (%)
Fever	2 122	2 118 (99.8)	329	325 (98.8)
Feeble	2 184	2 091 (95.7)	108	84 (77.8)
Myalgia	2 184	1 756 (80.4)	108	67 (62.0)
Headache	2 775	483 (17.4)	1 078	699 (64.8)
Arthralgia	2 691	158 (5.9)	694	228 (32.9)
Cough	2 180	1 092 (50.1)	419	59 (14.1)
Nausea	2 713	1 938 (71.4)	1 078	574 (53.2)
Vomiting	2 691	977 (36.3)	1 078	475 (44.1)
Diarrhoea	2 775	856 (30.8)	1 078	211 (19.6)
Abdominal pain	2 691	302 (11.2)	1 078	293 (27.2)
Facial flushing	284	28 (9.9)	811	330 (40.7)
Conjunctival congestion	595	44 (7.4)	1 078	444 (41.2)
Redness of neck	284	19 (6.7)	427	140 (32.8)
Petechia	2 691	119 (4.4)	694	136 (19.6)
Redness of chest	284	10 (3.5)	427	110 (25.8)
Haemoptysis	2 687	84 (3.1)	400	3 (0.8)
Hematuria	2 100	8 (0.4)	329	89 (27.1)
Lymphadenopathy	2 771	1 396 (50.4)	365	4 (1.1)
Oliguria	284	24 (8.5)	683	211 (30.9)
Icterus	595	3 (0.5)	659	18 (2.7)

Clinical symptom/sign	SFTS patient		HFRS patient
Clinical symptom/sign	Overall number of people	n (%)	Overall number of people	n (%)
Fever	2 122	2 118 (99.8)	329	325 (98.8)
Feeble	2 184	2 091 (95.7)	108	84 (77.8)
Myalgia	2 184	1 756 (80.4)	108	67 (62.0)
Headache	2 775	483 (17.4)	1 078	699 (64.8)
Arthralgia	2 691	158 (5.9)	694	228 (32.9)
Cough	2 180	1 092 (50.1)	419	59 (14.1)
Nausea	2 713	1 938 (71.4)	1 078	574 (53.2)
Vomiting	2 691	977 (36.3)	1 078	475 (44.1)
Diarrhoea	2 775	856 (30.8)	1 078	211 (19.6)
Abdominal pain	2 691	302 (11.2)	1 078	293 (27.2)
Facial flushing	284	28 (9.9)	811	330 (40.7)
Conjunctival congestion	595	44 (7.4)	1 078	444 (41.2)
Redness of neck	284	19 (6.7)	427	140 (32.8)
Petechia	2 691	119 (4.4)	694	136 (19.6)
Redness of chest	284	10 (3.5)	427	110 (25.8)
Haemoptysis	2 687	84 (3.1)	400	3 (0.8)
Hematuria	2 100	8 (0.4)	329	89 (27.1)
Lymphadenopathy	2 771	1 396 (50.4)	365	4 (1.1)
Oliguria	284	24 (8.5)	683	211 (30.9)
Icterus	595	3 (0.5)	659	18 (2.7)

Indicator	Reference range^①	SFTS patient	HFRS patient
White blood cell count/(μL^-1)	4 500‒11 000	2 501.9 (n=1 142)	11 891.2 (n=784)
Platelet/(×10⁹ L^-1)	150‒400	63.7 (n=1 142)	56.0 (n=784)
Hemoglobin/(g·dL^-1)	11.7‒16.1	13.2 (n=551)	13.9 (n=419)
Blood urea nitrogen/(mg·dL^-1)	8.0‒23.0	24.0 (n=57)	41.2 (n=419)
Creatinine/(mg·dL^-1)	0.6‒1.1	1.2 (n=240)	2.8 (n=419)
Glutamic-oxaloacetic transaminase/(IU·L^-1)	5‒45	281.0 (n=240)	323.6 (n=35)
Glutamic-pyruvic transaminase/(IU·L^-1)	10‒40	100.6 (n=240)	137.6 (n=35)
Lactate dehydrogenase/(IU·L^-1)	263‒450	1 093.3 (n=240)	1 331.0 (n=35)
Creatine kinase/(IU·L^-1)	32‒269	1 839.7 (n=240)	732.5 (n=35)
C-reactive protein/(mg·L^-1)	0‒3	18.1 (n=240)	28.0 (n=419)

Indicator	Reference range^①	SFTS patient	HFRS patient
White blood cell count/(μL^-1)	4 500‒11 000	2 501.9 (n=1 142)	11 891.2 (n=784)
Platelet/(×10⁹ L^-1)	150‒400	63.7 (n=1 142)	56.0 (n=784)
Hemoglobin/(g·dL^-1)	11.7‒16.1	13.2 (n=551)	13.9 (n=419)
Blood urea nitrogen/(mg·dL^-1)	8.0‒23.0	24.0 (n=57)	41.2 (n=419)
Creatinine/(mg·dL^-1)	0.6‒1.1	1.2 (n=240)	2.8 (n=419)
Glutamic-oxaloacetic transaminase/(IU·L^-1)	5‒45	281.0 (n=240)	323.6 (n=35)
Glutamic-pyruvic transaminase/(IU·L^-1)	10‒40	100.6 (n=240)	137.6 (n=35)
Lactate dehydrogenase/(IU·L^-1)	263‒450	1 093.3 (n=240)	1 331.0 (n=35)
Creatine kinase/(IU·L^-1)	32‒269	1 839.7 (n=240)	732.5 (n=35)
C-reactive protein/(mg·L^-1)	0‒3	18.1 (n=240)	28.0 (n=419)

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