摘要目的 了解埃博拉病毒病(EVD)患者就诊时临床特征,为医务人员提供对该病的诊治经验.方法 记录解放军医疗队首批援非医疗队在塞拉利昂塞中友好医院收治的62例疑似EVD患者接诊时患者信息、病史和症状.采用反转录(RT)-PCR检测明确或排除诊断,分析埃博拉病毒(EBOV)阳性和EBOV阴性患者在就诊时症状的差异.两组间患者年龄、发病至住院时间的比较采用成组t检验,率的比较采用x2检验.结果 62例留观者中,男35例,女27例,平均年龄(27.3±15.4)岁.EBOV阳性组40例,EBOV阴性组22例.EBOV阳性组患者潜伏期2～24 d,平均(8.8±5.7)d,且入院时发热、恶心或呕吐、腹泻、乏力、纳差、咽痛阳性率均高于EBOV阴性组患者(均P＜0.05);虽然眼痛、呃逆、失眠发生率在EBOV阳性组较低,但均未在EBOV阴性组出现.EBOV阳性组有1例患者入院时有血便.EBOV阳性组入院时平均出现(8±5)个症状,EBOV阴性组平均出现(4±3)个症状,两组比较差异有统计学意义(t=8.46,P=0.001).应用症状数量判断EVD的阈值为6,其敏感度为50.0％,特异度为86.4％,阳性预测值为87.0％,阴性预测值为48.7％.62例留观者中,36例有明确与EVD疑似或确诊者接触史,其中EBOV阳性组22例(55.0％),EBOV阴性组14例(63.6％),两组比较差异无统计学意义(x2 =0.44,P=0.596).在有明确接触史的36例留观者中,EBOV阳性组发热19例(86.4％)、乏力20例(90.9％),EBOV阴性组发热6例(42.9％)、乏力5例(35.7％),两组比较差异均有统计学意义(均P＜0.05).结论 在EVD疑似患者中,EBOV阳性患者较EBOV阴性患者在入院时阳性症状更多,主要为发热、恶心或呕吐、腹泻、乏力、纳差、咽痛等,虽然症状并非特异性诊断指标,但仍有助于医务人员对该病的早期识别.

abstractsObjective The aim of this study is to analyze the clinical features of patients with Ebola virus (EBOV) infection at admission and to provide information for clinicians to manage patients with suspected Ebola virus disease (EVD).Methods Sixty-two suspected EVD cases visited China-Sierra leone Friendship Hospital which was set up by the first medical team from the Chinese People's Liberation Army in Africa were enrolled in this study.Demographic information,medical history and symptoms were collected for all the patients at admission.Reverse transcription polymerase chain reaction (RT-PCR) was used to confirm or exclude the diagnosis.Data were compared between patients with or without EBOV infection by t test for ages,days from symptoms onset to admission,and x2 test for proportion of symptoms.Results Of 62 patients,35 were male and 27 were female,average age was (27.3 ± 15.4) years.Forty cases were diagnosed with EVD,and 22 were excluded.The incubation period for EVD patients was estimated to be 2 to 24 days with an average of (8.8±5.7) days.EBOV positive patients showed higher proportions of fever,nausea/vomiting,diarrhea,fatigue/weakness,loss of appetite and sore throat than those of EBOV negative patients (all P＜0.05).The proportions of eye pain,hiccup and insomnia were low in EBOV positive patients,while none was in EBOV negative patients.Only one patient had bloody stool at admission.An average of (8 ± 5) symptoms were noted in EVD patients at admission compared with (4±3) symptoms in non-EVD patients (t =8.46,P =0.001).The number of symptoms at admission was optimal in diagnosing EVD with cut-off value of 6.The sensitivity,specificity,positive predictive value and negative predictive value were 50.0％,86.4％,87.0％ and 48.7％,respectively.Thirty-six out of 62 patients had a history of contact with confirmed or suspected EVD cases,including 22 (55.0％) in EBOV positive patients and 14(63.6％) in EBOV negative patients (x2 =0.44,P=0.596).Among 36 cases with definite EVD contact history,19 (86.4％) presented with fever and 20(90.9％) presented with fatigue in EBOV positive patients,while 6 (42.9 ％) presented with fever and 5 (35.7 ％) presented with fatigue in EBOV negative patients (both P＜0.05).Conclusions Among suspected EVD patients,those who are diagnosed with EVD by RT-PCR have more symptoms than those with negative results,including fever,nausea/vomiting,diarrhea,fatigue/weakness,loss of appetite and sore throat,etc.Though these symptoms are not specific,they provide clues for diagnose EVD in the very early stage for clinicians.