儿童肾综合征出血热临床特征及重症危险因素分析OACSTPCD

Objective To study the clinical features and risk factors of severe hemorrhagic fever with renal syndrome(HFRS)in children,and to accumulate experience in the diagnosis and treatment of HFRS.Methods A retrospective analysis was performed on the clinical data of 150 children with HFRS who were ad-mitted to the department of Infectious Diseases of the hospital from January 2019 to December 2021.The epi-demiological characteristics,clinical manifestations,laboratory examination results,diagnosis and treatment outcomes were analyzed.The clinical manifestations of HFRS are divided into 4 types:mild,moderate,severe,and critical.Patients with mild and moderate HFRS were divided into mild HFRS group(101 cases).Severe and critical type were divided into severe HFRS group(49 cases).The differences of clinical manifestations and laboratory examination indexes between severe HFRS group and mild HFRS group were compared and analyzed.Results The peak months of the 150 children were November and December.Most of the children lived in rural areas(89.33％),and the regional distribution was most in Xi'an(80.00％).Among the 150 children with HFRS,110 were males and 40 were females,with a sex ratio of 2.75:1.00.The age group with the highest proportion was＞6-12 years old(56.67％).The length of hospital stay,the duration of fever,the symptoms of redness and flushing of the skin and mucosa of the face,pharynx,neck and chest(three red),and the incidence of skin ecchymosis in the severe HFRS group were higher than those in the mild HFRS group,and the differences were statistically significant(P＜0.05).The levels of white blood cell count,pro-calcitonin,alanine aminotransferase,urea nitrogen,creatinine,creatine kinase isoenzyme,urine protein and u-rine red blood cell positive proportion in the severe HFRS group were higher than those in the mild HFRS group,and the levels of platelet count,albumin,serum sodium and potassium were lower than those in the mild HFRS group,and the differences were statistically significant(P＜0.05).Multivariate Logistic regres-sion analysis showed that decreased albumin level and increased creatine kinase isoenzyme level were inde-pendent risk factors for severe HFRS(P＜0.05).The results of receiver operating characteristic curve analy-sis showed that when the optimal cut-off values of albumin and creatine kinase isoenzyme were 30.5 g/L and 31.5 U/L,the areas under the curve for the diagnosis of severe HFRS were 0.882 and 0.767 respectively.A-mong the 150 children with HFRS,20 children were treated with blood purification,8 children were treated with invasive ventilator assisted ventilation,and all children were cured and discharged.Conclusion The clini-cal manifestations of HFRS are atypical,and it is easy to be missed and misdiagnosed.Decreased albumin level and increased creatine kinase isoenzyme level are risk factors for severe HFRS.