ABSTRACT
Objective:To analyze the clinical characteristics and prognostic factors of severe fever with thrombocytopenia syndrome patients with high novel Bunya viral load.Methods:The clinical data of 141 patients with severe fever with thrombocytopenia syndrome whose viral load higher than 1×10 4 copies/mL were retrospectively collected from May 20, 2013 to October 30, 2019 in Weihai Central Hospital. All patients were diagnosed by laboratory tests. According to the prognosis, the cases were divided into survival group and death group. The clinical manifestations, laboratory test results and the influence of viral load on the conditions and the risk factors of prognosis were compared and analyzed. Chi-square test, rank sum test and logistic regression analysis were used for statistical analysis. Results:There were 76 patients in survival group, with a median age of 64 years. There were 65 patients in death group, with a median age of 71 years. There were significant differences in neurological injury, coma, hemorrhage, atrial fibrillation with rapid ventricular rate, and renal injury between the survival group and the death group ( χ2=16.45, 64.06, 11.25, 6.98 and 33.80, respectively, all P<0.01). There were significant differences in activated partial thromboplastin time (APTT), aspartate aminotransferase (AST), creatine kinase (CK), creatine kinase isoenzymes (CK-MB), lactic acid dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatinine, and platelet count between the survival group and the death group ( Z=6.33, 4.51, 2.93, 4.65, 5.00, 4.93, 5.36 and -4.34, respectively, all P<0.01). The RNA quantification of viral load in 138 cases ranged from 1.06×10 4 to 6.53×10 7 copies/mL, and the remaining three cases were higher than 1.00×10 8 copies/mL. The viral load of the two groups were 4.63(4.32, 5.22) and 5.29(4.92, 6.17) lg copies/mL, respectively ( Z=4.91, P<0.01). The mortalities of patients with viral loads of 1.00×10 4-<1.00×10 5 copies/mL, 1.00×10 5-<1.00×10 6 copies/mL and 1.00×10 6-<1.00×10 7 copies/mL were 29.33%(22/75), 51.28%(20/39), 80.95% (17/21), respectively. Six cases with viral loads higher than 1.00×10 7 copies/mL were dead. Logistic regression analysis showed that when age ≥60 years old, viral load >1.00×10 6 copies/mL, platelet count <30.00×10 9/L, LDH ≥5 000.00 U/L, APTT ≥84.00 s, the risk of death increased significantly. Conclusions:The occurrences of coma, hemorrhage, atrial fibrillation with rapid ventricular rate, renal injury suggest that the patients′ conditions are more serious and the risk of death is higher. Age, viral load, platelet count, LDH and APTT can be used as indicators to assess the risk of death.
ABSTRACT
Objective To determine the effects of a health management program based on WeChat platform of overweight and obese diabetic high-risk population and to provide the basis for developing a scientific and effective weight loss program. Methods A total of 123 overweight and obese diabetic cases were identified during health examinations and were randomly divided into intervention(n=62)and control (n=61)groups.In the control group,traditional health lectures once a week for 3 months were conducted.In the intervention group,based on the control group using a micro-classroom setting to give diet and exercise interventions, diabetes information and intervention programs were uploaded to the WeChat learning platform, arranged at a fixed time with the patient online learning exchange, and with complete follow-up services. Low-energy intake therapy was used for diet intervention program, the daily calorie intake decreased by 15% to 40%;aerobic exercise combined with appropriate strength training were used as part of the exercise intervention program.Both groups were followed up for 1 year,measuring the dietary,exercise compliance, body mass index (BMI), body fat, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose (FBG) levels. Blood lipids, blood glucose, and weight loss were analyzed using an independent sample t-test and χ2test. Results The difference in the educational participation rate between the intervention (81.0%, 583/720) and control (72.9%, (516/708) groups was statistically significant(χ2=13.18,P<0.05).The reasonable proportions of carbohydrate,protein, fat, and salt were 85.0%, 70.0%, 73.0%, and 75.0%, respectively, in the intervention group, which were significantly higher than those in the control group(66.0%,47.6%,49.2%,and 52.5 %,respectively),The difference was statistically significant(χ2=5.76,6.24,7.34,6.50,all P<0.05).To compare the daily effective exercise time,the intervention group(22.8±2.1)min was significantly longer than the control group(16.2± 1.8)min,with a statistically significant difference(t=18.33,P<0.01).The TC,TG,LDL-C,and FBG levels in the intervention group [(4.9 ± 0.4) mmol/L, (1.5 ± 0.2) mmol/L, (2.7 ± 0.3) mmol/L, and (4.9 ± 0.6) mmol/L, respectively]were significantly lower than those in the control group[(5.6±0.4)mmol/L,(2.1±0.2)mmol/L, (3.9±0.3)mmol/L,and(5.8±0.6)mmol/L,respectively].The BMI in the intervention group(24.3±2.8)kg/m2 was significantly lower than that in the control group(27.8±2.9)kg/m2.Moreover,the mean level of body fat in the intervention group (19.6 ± 1.9) kg was lower than that in the control group (22.6 ± 2.1) kg, with a statistically significant difference (t=9.54, 15.93, 22.56, 8.54, 6.72, 8.22, all P<0.01). The effective rate of weight loss and fat loss was 65.0% and 60.0% in the intervention group,which were significantly higher than those in the control group (35.6% and 32.2%, respectively), with a statistically significant difference (χ2=10.29, 9.25, all P<0.05). Conclusion The health management program based on a micro-letter platform can improve the participation in the intervention and reasonable diet and exercise compliance and effectively reduce the weight and blood lipid and glucose levels of overweight and obese diabetic patients.