严重发热伴血小板减少综合征患者皮质类固醇治疗的效果：一项单中心回顾性队列研究。
Effects of corticosteroid treatment in patients with severe fever with thrombocytopenia syndrome: A single-center retrospective cohort study.
机构信息
Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China; Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan 43000, China; Department of Transfusion, Zhongshan Hospital (Xiamen), Fudan University, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, 361015, China.
Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China; Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan 43000, China.
出版信息
Int J Infect Dis. 2022 Sep;122:1026-1033. doi: 10.1016/j.ijid.2022.07.001. Epub 2022 Jul 6.
OBJECTIVES
To evaluate the effect and safety of corticosteroid (CS) treatment in patients with severe fever with thrombocytopenia syndrome (SFTS).
METHODS
Patients with and without CS were retrospectively compared by Cox regression and 1:1 propensity score matching analysis to evaluate the effects of CS on mortality and secondary infections in patients with SFTS.
RESULTS
A total of 467 patients with SFTS were enrolled in the cohort study, there were 52 fatal cases and 415 nonfatal cases, the overall fatality rate was 11.1%. The mortality was observed in 36/144 (25%) and 16/323 (5%) patients in the CS-treated and non-CS-treated groups, respectively (P < 0.001). Multi variate Cox regression analysis showed that the difference was not statistically significant for CS treatment in fatality (P > 0.05, aHR 0.767, 95% CI 0.360-1.634). Difference in survival time between the CS-treated and non-CS-treated groups after propensity score matching had no statistical significance (Log-rank test P = 0.390), whereas there was a significant difference in secondary infections between the CS-treated and non-CS-treated groups (P = 0.007).
CONCLUSION
Although the CS treatment had no impact on fatality in patients with SFTS, it increased the risk of secondary infections. Administration of CS in patients with SFTS should be carefully considered and evaluated the balance between therapeutic efficacy and adverse effects.
目的
评估皮质类固醇（CS）治疗严重发热伴血小板减少综合征（SFTS）患者的效果和安全性。
方法
通过 Cox 回归和 1:1 倾向评分匹配分析，比较了 CS 治疗组和非 CS 治疗组患者的疗效，评估 CS 对 SFTS 患者死亡率和继发感染的影响。
结果
共纳入 467 例 SFTS 患者进行队列研究，其中 52 例死亡，415 例存活，总病死率为 11.1%。CS 治疗组和非 CS 治疗组的死亡率分别为 36/144（25%）和 16/323（5%）（P<0.001）。多变量 Cox 回归分析显示，CS 治疗对病死率的差异无统计学意义（P>0.05，aHR 0.767，95%CI 0.360-1.634）。倾向评分匹配后 CS 治疗组与非 CS 治疗组的生存时间差异无统计学意义（Log-rank 检验 P=0.390），但 CS 治疗组与非 CS 治疗组的继发感染差异有统计学意义（P=0.007）。
结论
虽然 CS 治疗对 SFTS 患者的病死率无影响，但增加了继发感染的风险。CS 在 SFTS 患者中的应用应慎重考虑，并评估治疗效果与不良反应之间的平衡。
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