Miyashima Yuichi, Iwamuro Masaya, Shibata Michihiko, Miyabe Yoshio, Kawai Yoshinari, Kaihara Masanobu, Mitogawa Takehide, Harada Masaru
Department of Gastroenterology, Onomichi Municipal Hospital, Japan.
Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan.
Intern Med. 2018 Jan 15;57(2):197-202. doi: 10.2169/internalmedicine.8420-16. Epub 2017 Oct 11.
Objective Cases of Japanese spotted fever (JSF) are sometimes complicated by disseminated intravascular coagulation (DIC) with an abnormal liver function, resulting in unfavorable outcomes. The aim of the present study was to clarify the correlation between liver function test results and DIC scores. Methods Twenty patients diagnosed with JSF between April 2010 and April 2014 were enrolled. Age, gender, disturbance of consciousness, body temperature, pulse rate, presence of diffuse erythema, eschar and swelling of lymph nodes, laboratory test results at the time of initial presentation such as blood cell count, C-reactive protein, liver function, renal function and blood coagulation and fibrinolysis, maximum Japanese Association for Acute Medicine (JAAM) DIC score during the course of JSF, treatment and the prognosis were retrospectively reviewed. Results The median age of the patients (8 men, 12 women) was 68.3 years. There were significant differences in the alkaline phosphatase (ALP) and rothrombin time international normalized ratio (PT-INR) between the DIC and non-DIC groups using Mann-Whitney's U test. A multiple logistic regression analysis showed that the ALP and blood urea nitrogen (BUN) levels at the time of initial presentation were independent predictors of the occurrence of DIC. Conclusion We should pay special attention to JSF patients showing high levels of ALP at the initial presentation, since such patients may have a higher likelihood of developing DIC over the course of JSF and unfavorable outcomes than those with lower levels.
目的 日本斑点热（JSF）病例有时会并发伴有肝功能异常的弥散性血管内凝血（DIC），导致不良预后。本研究的目的是阐明肝功能检查结果与DIC评分之间的相关性。方法 纳入2010年4月至2014年4月期间诊断为JSF的20例患者。回顾性分析患者的年龄、性别、意识障碍、体温、脉搏率、是否存在弥漫性红斑、焦痂和淋巴结肿大、初次就诊时的实验室检查结果，如血细胞计数、C反应蛋白、肝功能、肾功能以及血液凝固和纤维蛋白溶解情况、JSF病程中的最高日本急性医学协会（JAAM）DIC评分、治疗情况及预后。结果 患者（8例男性，12例女性）的中位年龄为68.3岁。采用曼-惠特尼U检验，DIC组和非DIC组之间的碱性磷酸酶（ALP）和凝血酶原时间国际标准化比值（PT-INR）存在显著差异。多因素逻辑回归分析显示，初次就诊时的ALP水平和血尿素氮（BUN）水平是DIC发生的独立预测因素。结论 对于初次就诊时ALP水平较高的JSF患者，我们应特别关注，因为这类患者在JSF病程中发生DIC及出现不良预后的可能性可能高于ALP水平较低的患者。
