恙虫病并发多器官功能障碍综合征 及死亡预测因素研究

Predictive factors of multiple organ disfunction syndrome and death in patients with scrub typhus

摘要:

目的 探讨恙虫病并发多器官功能障碍综合征（MODS）的临床特征，及其发生和导致死亡的预 测因素。方法 回顾性分析恙虫病268 例，其中MODS 17 例。对比MODS 组与非MODS 组临床资料的差 异并对各因素进行多因素Logistic 回归分析；分析MODS 患者各个器官功能衰竭的情况，对比MODS 死亡 组和存活组临床资料的差异。结果 恙虫病MODS 组白细胞增多、血小板减少、血肌酐升高、降钙素原> 0.5 μg/L 者比例高于非MODS 组，差异有统计学意义（P <0.05）；多因素Logistic 回归分析显示血小板减少 （O^R=19.014，95%CI ：4.239，85.280）、血肌酐升高（O^R=113.286，95%CI ：29.3914，36.649）为MODS 发生的 预测因素（P <0.05）。MODS 患者各个器官功能衰竭早期或衰竭期发生率由高自低依次为：凝血功能、肺、外 周循环、心脏、脑、肝、肾、胃肠道、代谢；MODS 死亡组急性呼吸窘迫综合征或急性肺损伤的发生率高 于存活组，差异有统计学意义（P <0.05）。结论 血小板减少、血肌酐升高有预警恙虫病MODS 发生的价值； 恙虫病MODS 患者发生急性呼吸窘迫综合征或急性肺损伤提示可能预后不良。

Abstract:

Objective To investigate the predictive factors of multiple organ disfunction syndrome (MODS) or death in patients with scrub typhus. Methods A total of 268 cases of scrub typhus were involved in this study, among which were 17 cases with MODS. Clinical information were recorded and analyzed. Result Patients in MODS group experienced increased incidence of leukocytosis, thrombocytopenia, elevated levels of serum creatinine (SCr), and procalcitonin > 0.5 μg/L compared with non-MODS group (P < 0.05). Multivariate logistic regression analysis showed thrombocytopenia and elevated levels of SCr were independent predictive factors of MODS (O^R = 19.014, 95% CI: 4.239, 85.280, Ol ^ R = 113.286, 95% CI: 29.3914, 36.649, respectively). Occurrence of organ failure (from highest to lowest) was as follows: blood coagulation, lung, peripheral blood circulation, heart, brain, liver, kidney, gastrointestinal tract and metabolism. Incidence of acute respiratory distress syndrome in MODS group were dramatically increased compared with non-MODS group (P < 0.05). Conclusion Thrombocytopenia and elevated levels of SCr are associated with the occurrence of MODS, and ARDS indicates poor prognosis in patients with scrub typhus.