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.
Keywords：severe fever with thrombocytopenia syndrome (SFTS)
;
hemorrhagic fever with renal syndrome (HFRS)
;
diagnosis
;
differential diagnosis
YAN Wenyue, LI Qiang. Research progress in diagnosis and differential diagnosis of severe fever with thrombocytopenia syndrome and hemorrhagic fever with renal syndrome. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2023, 43(11): 1457-1462 doi:10.3969/j.issn.1674-8115.2023.11.015
发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome，SFTS）是一种新型传染性疾病，2009年于中国被首次发现，其致病病毒——SFTS病毒于2013年在中国被首次命名［1］。随后，日本、韩国、美国、越南等国家亦有相关病例的报道［2］。肾综合征出血热（hemorrhagic fever with renal syndrome，HFRS）是一种由汉坦病毒属的各型病毒引起的自然疫源性疾病，早在1931年于中国东北被首次发现，朝鲜战争期间（1950—1953年）因3 000多名联合国士兵被感染而引起世界的关注［3］。HFRS呈世界性流行，在中国的疫情最为严重，其患者人数占全球HFRS病例总数的70%~90%［3］。临床上，某些地区由于医疗设施的不完善，医师尚无法获得SFTS和HFRS诊断所必需的实验室检查结果，进而使得对该2种疾病的诊断及鉴别诊断能力不足，易造成疾病的漏诊或误诊，最终导致患者病情加重并影响其预后。为提高临床医师的诊断水平和鉴别诊断水平，本文就SFTS和HFRS的流行病学、临床表现、实验室检查、诊断、治疗及预后等方面的最新进展进行综述。
Note: The data in the table are all mean (overall number of people). ①The reference range quotes from the research of NOH, et al[15]. Because there is no clear conversion formula between the unit IU/L and U/L, these four indicators (glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, lactate dehydrogenase and creatine kinase) in the table do not include case data of China.
This review was drafted by YAN Wenyue. LI Qiang was responsible for the guidance and revision of the paper. Both authors have read the last version of paper and consented for submission.
利益冲突声明
两位作者声明不存在利益冲突。
COMPETING INTERESTS
Both authors disclose no relevant conflict of interests.
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... Laboratory test results of SFTS and HFRS patientsTab 2
Indicator
Reference range①
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)
Note: The data in the table are all mean (overall number of people). ①The reference range quotes from the research of NOH, et al[15]. Because there is no clear conversion formula between the unit IU/L and U/L, these four indicators (glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, lactate dehydrogenase and creatine kinase) in the table do not include case data of China. ...
... Laboratory test results of SFTS and HFRS patientsTab 2
Indicator
Reference range①
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)
Note: The data in the table are all mean (overall number of people). ①The reference range quotes from the research of NOH, et al[15]. Because there is no clear conversion formula between the unit IU/L and U/L, these four indicators (glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, lactate dehydrogenase and creatine kinase) in the table do not include case data of China. ...
... Note: The data in the table are all mean (overall number of people). ①The reference range quotes from the research of NOH, et al[15]. Because there is no clear conversion formula between the unit IU/L and U/L, these four indicators (glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, lactate dehydrogenase and creatine kinase) in the table do not include case data of China. ...
