发热伴血小板减少综合征合并噬血细胞综合征2例诊疗分析

doi:10.3969/j.issn.1674-8115.2025.10.016

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (10): 1400-1406.doi: 10.3969/j.issn.1674-8115.2025.10.016

• 病例报告 • 上一篇

发热伴血小板减少综合征合并噬血细胞综合征2例诊疗分析

乔靓¹^,²^,³, 张婷娟¹^,²^,³, 冯媛¹^,²^,³, 杨磊¹^,²^,³, 钱军¹^,²^,³, 周静东¹^,²^,³()

^1.江苏大学附属人民医院血液科，镇江 212002
^2.江苏省镇江市血液病临床医学研究中心，镇江 212002
^3.江苏省镇江市血液系统恶性肿瘤精准诊断与治疗重点实验室，镇江 212002

收稿日期:2025-04-09 接受日期:2025-06-19 出版日期:2025-10-28 发布日期:2025-10-28
通讯作者: 周静东，副主任医师，博士；电子信箱：zhoujingdong@ujs.edu.cn。
基金资助:
国家自然科学基金(82270179);江苏省自然科学基金(BK20221287);江苏省卫生健康员会科研项目(M2022123)

Diagnosis and treatment analysis of two cases of severe fever with thrombocytopenia syndrome complicated with hemophagocytic lymphohistiocytosis

QIAO Liang¹^,²^,³, ZHANG Tingjuan¹^,²^,³, FENG Yuan¹^,²^,³, YANG Lei¹^,²^,³, QIAN Jun¹^,²^,³, ZHOU Jingdong¹^,²^,³()

^1.Department of Hematology, Affiliated People's Hospital of Jiangsu University, Zhenjiang 212002, China
^2.Zhenjiang Clinical Research Center of Hematology, Jiangsu Province, Zhenjiang 212002, China
^3.The Key Lab of Precision Diagnosis and Treatment of Zhenjiang City, Jiangsu Province, Zhenjiang 212002, China

Received:2025-04-09 Accepted:2025-06-19 Online:2025-10-28 Published:2025-10-28
Contact: ZHOU Jingdong, E-mail: zhoujingdong@ujs.edu.cn.
Supported by:
National Natural Science Foundation of China(82270179);Jiangsu Provincial Natural Science Foundation(BK20221287);Jiangsu Commission of Health Scientific Research Project(M2022123)

摘要/Abstract

摘要：

病例1，患者男性，69岁，因“头晕乏力、恶心腹泻伴口腔出血10 d”就诊，近期有田间劳作史。患者出现白细胞、血小板减少，同时伴有凝血功能障碍、肝功能异常、胃肠道紊乱、心肌损伤、呼吸衰竭等多器官功能障碍的临床表现，骨髓穿刺涂片结果见噬血现象，外送新型布尼亚病毒检测显示阳性，确诊为发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome，SFTS）合并噬血细胞综合征（hemophagocytic lymphohistiocytosis，HLH）。确诊后启动糖皮质激素联合利巴韦林治疗，但随访得知患者死亡，原因可能与患者就诊偏晚、高龄、病毒复制未能较好控制等因素有关。病例2，患者男性，73岁，因“乏力1周”就诊，近期有田间劳作史。患者同样有白细胞、血小板减少，合并肝功能、凝血功能异常，骨髓穿刺涂片可见噬血现象，考虑患者高度疑似SFTS伴HLH。予经验性抢先使用法维拉韦抗病毒联合糖皮质激素抗炎治疗，早期抑制新型布尼亚病毒复制及炎症因子风暴。其后检测结果显示患者新型布尼亚病毒核酸定量2.69×10³半数组织细胞感染剂量（50% tissue culture infective dose，TCID₅₀）/mL，确诊SFTS伴发HLH。患者最终临床症状及各项指标总体改善。通过2例类似病例复习提示临床上早期经验性抢先使用法维拉韦控制病毒复制可改善SFTS合并HLH患者的治疗与预后。

关键词: 发热伴血小板减少综合征, 噬血细胞综合征, 法维拉韦

Abstract:

Case 1, a 69-year-old male patient, was admitted to our hospital due to "dizziness, fatigue, nausea, diarrhea, and oral bleeding for 10 d", with a recent history of field farming work. The patient exhibited leukopenia, thrombocytopenia, and clinical manifestations of multi-organ dysfunction, including coagulation dysfunction, liver function abnormalities, gastrointestinal disorders, myocardial injury, and respiratory failure. Bone marrow aspiration smear revealed hemophagocytosis, and out-of-hospital testing for the severe fever with thrombocytopenia syndrome bunyavirus was positive. The patient was diagnosed with severe fever with thrombocytopenia syndrome (SFTS) complicated by hemophagocytic lymphohistiocytosis (HLH). After diagnosis, glucocorticoid combined with ribavirin treatment was initiated. However, the patient still died, which may be related to factors such as delayed medical consultation, advanced age, and poor control of viral replication. Case 2, a 73-year-old male patient, was admitted to our hospital due to "fatigue for 1 week", with a recent history of field farming work. The patient also presented with leukopenia and thrombocytopenia, combined with liver and coagulation function abnormalities. Bone marrow aspiration smear showed hemophagocytosis, and the patient was highly suspected of SFTS with HLH. We empirically initiated preemptive treatment with favipiravir for antiviral therapy, combined with glucocorticoid for anti-inflammation, to early inhibit novel bunyavirus replication and cytokine storm. Subsequent testing reported the severe fever with thrombocytopenia syndrome bunyavirus nucleic acid quantification as 2.69×10³ 50% tissue culture infective dose (TCID₅₀)/mL, confirming the diagnosis of SFTS with HLH. The patient's clinical symptoms and various indicators generally improved. Review of these two similar cases suggests that early empirical preemptive use of favipiravir to control viral replication in clinical practice may improve the treatment and prognosis of patients with SFTS complicated by HLH.

Key words: severe fever with thrombocytopenia syndrome (SFTS), hemophagocytic lymphohistiocytosis (HLH), favipiravir

中图分类号:

R320.2455

乔靓, 张婷娟, 冯媛, 杨磊, 钱军, 周静东. 发热伴血小板减少综合征合并噬血细胞综合征2例诊疗分析[J]. 上海交通大学学报（医学版）, 2025, 45(10): 1400-1406.

QIAO Liang, ZHANG Tingjuan, FENG Yuan, YANG Lei, QIAN Jun, ZHOU Jingdong. Diagnosis and treatment analysis of two cases of severe fever with thrombocytopenia syndrome complicated with hemophagocytic lymphohistiocytosis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(10): 1400-1406.

图/表 3

参考文献 29

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Item	2024-04-21	2024-04-22	2024-04-23	2024-04-24	2024-04-25	2024-04-26
CRP/(mg·L^-1)	1.17	14.05	11.68	6.52	16.56	32.73
WBC/(×10⁹·L^-1)	1.08	0.95	2.16	3.48	4.80	12.07
Neu/(×10⁹·L^-1)	0.91	0.80	1.73	2.55	2.60	6.99
Lym/(×10⁹·L^-1)	0.12	0.12	0.35	0.79	0.65	1.59
Hb/(g·L^-1)	133	130	135	135	131	152
PLT/(×10⁹·L^-1)	40	27	31	26	36	81
ALT/(U·L^-1)	‒	89	‒	‒	173	‒
AST/(U·L^-1)	216	243	384	524	803	‒
LDH/(U·L^-1)	694	678	947	1 427	4 350	‒
CK/(U·L^-1)	3 440	2 755	3 627	3 978	5 900	‒
CK-MB/(U·L^-1)	17.10	‒	29.90	63.20	62.30	‒
cTNI/(ng·mL^-1)	0.02	‒	0.06	0.13	0.41	0.71
NT-proBNP/(pg·mL^-1)	20.00	‒	49.80	211.74	2 676.63	10 981.63

Item	2024-04-21	2024-04-22	2024-04-23	2024-04-24	2024-04-25	2024-04-26
CRP/(mg·L^-1)	1.17	14.05	11.68	6.52	16.56	32.73
WBC/(×10⁹·L^-1)	1.08	0.95	2.16	3.48	4.80	12.07
Neu/(×10⁹·L^-1)	0.91	0.80	1.73	2.55	2.60	6.99
Lym/(×10⁹·L^-1)	0.12	0.12	0.35	0.79	0.65	1.59
Hb/(g·L^-1)	133	130	135	135	131	152
PLT/(×10⁹·L^-1)	40	27	31	26	36	81
ALT/(U·L^-1)	‒	89	‒	‒	173	‒
AST/(U·L^-1)	216	243	384	524	803	‒
LDH/(U·L^-1)	694	678	947	1 427	4 350	‒
CK/(U·L^-1)	3 440	2 755	3 627	3 978	5 900	‒
CK-MB/(U·L^-1)	17.10	‒	29.90	63.20	62.30	‒
cTNI/(ng·mL^-1)	0.02	‒	0.06	0.13	0.41	0.71
NT-proBNP/(pg·mL^-1)	20.00	‒	49.80	211.74	2 676.63	10 981.63

发热伴血小板减少综合征合并噬血细胞综合征2例诊疗分析

Diagnosis and treatment analysis of two cases of severe fever with thrombocytopenia syndrome complicated with hemophagocytic lymphohistiocytosis

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