Xu L, Wang H, Liang B Y, Wang T, Zheng X, Peng C
Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 432200, China.
Zhonghua Nei Ke Za Zhi. 2022 Jul 1;61(7):793-796. doi: 10.3760/cma.j.cn112138-20211013-00702.
To analyze the changes of coagulation function in severe fever with thrombocytopenia syndrome (SFTS) and its relationship with thrombocytopenia, and to explore its value as an early predictor of the severity of SFTS. The clinical data of 428 SFTS patients (70 deaths and 358 survivors) admitted to the Department of Infectious Disease at Wuhan Union Hospital from January 2014 to July 2020 were retrospectively analyzed. The differences of coagulation parameters and disseminated intravascular coagulation (DIC) scores between the two groups were compared. The results showed that abnormal coagulation function was commonly presented in SFTS patients. Bleeding was more frequent in mortality group (41.4% vs. 26.5%). The D-dimer levels in mortality patients were significantly higher above normal range. Activated partial thrombin time (APTT) and thrombin time (TT) were significantly prolonged. The levels of prothrombin time (PT), TT, APTT, international standardized ratio (INR) and D-dimer between mortality group and survival group started to separate from day 5-6. The difference of fibrinogen (FIB) level developed on day 7-8, while platelet counts between the two groups were significant different from day 9-10. The mortality rate increased according to the increase of baseline DIC score. When DIC score reached 6, the mortality rate surged to 66.67%. Excessive platelet consumption is mediated by significant coagulation abnormalities during disease course, and coagulation parameters are more sensitive than platelet count as an early predictor of severe SFTS.
分析发热伴血小板减少综合征（SFTS）患者凝血功能变化及其与血小板减少的关系，探讨其作为SFTS严重程度早期预测指标的价值。回顾性分析2014年1月至2020年7月在武汉协和医院感染科收治的428例SFTS患者（70例死亡，358例存活）的临床资料。比较两组凝血参数及弥散性血管内凝血（DIC）评分的差异。结果显示，SFTS患者普遍存在凝血功能异常。死亡组出血更常见（41.4%对26.5%）。死亡患者D-二聚体水平显著高于正常范围。活化部分凝血活酶时间（APTT）和凝血酶时间（TT）显著延长。死亡组与存活组的凝血酶原时间（PT）、TT、APTT、国际标准化比值（INR）和D-二聚体水平在第5 - 6天开始出现分离。纤维蛋白原（FIB）水平差异在第7 - 8天出现，而两组血小板计数在第9 - 10天有显著差异。死亡率随基线DIC评分增加而升高。当DIC评分达到6分时，死亡率飙升至66.67%。疾病过程中显著的凝血异常介导了血小板过度消耗，凝血参数作为SFTS严重程度的早期预测指标比血小板计数更敏感。
