Elaldi Nazif, Bodur Hurrem, Ascioglu Sibel, Celikbas Aysel, Ozkurt Zulal, Vahaboglu Haluk, Leblebicioglu Hakan, Yilmaz Neziha, Engin Aynur, Sencan Mehmet, Aydin Kemalettin, Dokmetas Ilyas, Cevik Mustafa Aydin, Dokuzoguz Basak, Tasyaran Mehmet Ali, Ozturk Recep, Bakir Mehmet, Uzun Ramazan
Department of Infectious Diseases and Clinical Bacteriology, Cumhuriyet University, Sivas, Turkey.
J Infect. 2009 Mar;58(3):238-44. doi: 10.1016/j.jinf.2009.01.014. Epub 2009 Feb 26.
The aim of this study was to evaluate the efficacy of oral ribavirin treatment in patients with Crimean-Congo haemorrhagic fever (CCHF).
In 2004, all patients diagnosed with CCHF were treated with oral ribavirin, however in 2003 none of the CCHF patients had been given treatment due to lack of confirmatory diagnostic information at that time in Turkey. In this study, patients treated with ribavirin in 2004 (n=126) were compared with ribavirin-untreated CCHF patients (n=92) in 2003. Patients only with a definitive diagnosis of CCHF (clinical symptoms plus the presence of specific IgM antibodies against CCHF virus and presence of viral antigen) were included in this study.
There was no difference in the case-fatality rate between treated and untreated patients (7.1% vs. 11.9%; P>0.05). A Cox Proportional Hazards regression analysis revealed that altered sensorium and prolonged international normalized ratio were independent predictors of mortality.
Our results showed that oral ribavirin treatment did not improve the survival rate in CCHF patients. Ribavirin and supportive care are the only available choices for treatment of CCHF patients, but to ascertain the efficacy of ribavirin, more laboratory and observational studies are necessary and ultimately, to elucidate these conflicting results and evaluate the efficacy undoubtedly, a multicenter randomised controlled trial will be needed.
本研究旨在评估口服利巴韦林治疗克里米亚-刚果出血热（CCHF）患者的疗效。
2004年，所有诊断为CCHF的患者均接受口服利巴韦林治疗，然而在2003年，由于当时土耳其缺乏确诊诊断信息，没有一名CCHF患者接受治疗。在本研究中，将2004年接受利巴韦林治疗的患者（n = 126）与2003年未接受利巴韦林治疗的CCHF患者（n = 92）进行比较。本研究仅纳入确诊为CCHF的患者（临床症状加上存在针对CCHF病毒的特异性IgM抗体以及病毒抗原）。
治疗组和未治疗组的病死率无差异（7.1%对11.9%；P>0.05）。Cox比例风险回归分析显示，意识改变和国际标准化比值延长是死亡的独立预测因素。
我们的结果表明，口服利巴韦林治疗并不能提高CCHF患者的生存率。利巴韦林和支持性治疗是治疗CCHF患者的唯一可用选择，但要确定利巴韦林的疗效，需要更多的实验室和观察性研究，最终，为了阐明这些相互矛盾的结果并无疑地评估疗效，将需要进行多中心随机对照试验。
