Department of Infectious Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Department of Infectious Disease, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
Virol J. 2024 Aug 7;21(1):179. doi: 10.1186/s12985-024-02452-5.
Epstein-Barr virus (EBV) can be reactivated and proliferated with fatal outcome in immuno-compromised people, but the clinical consequences of EBV infection in patients with severe fever with thrombocytopenia syndrome (SFTS) remain uncertain. In this study, we investigated the infection rate, the influence and the early predictors of EBV infection in SFTS patients.
In this retrospective study, SFTS patients who were treated in the First Affiliated Hospital of Nanjing Medical University from May 2011 to August 2021 were enrolled and divided into infected and non-infected groups. We compared the demographic characteristics, clinical manifestations and signs, laboratory tests and prognosis, and explored the risk factors of EBV infection by receiver operating characteristic (ROC) curve and logistic regression.
A total of 120 hospitalized SFTS patients with EBV-DNA testing were enrolled in this study. Patients with EBV infection had statistically significant higher mortality rate (32.0% vs. 11.43%, P = 0.005). Compared with the non-infected group, the EBV-infected group had higher levels of C-reactive protein (CRP), creatine-kinase (CK), fasting blood glucose (FBG), blood urea nitrogen (BUN), D-dimer, and CD56 cell counts, lower levels of immunoglobulin G (IgG), IgM, complement 3 (C3), and C4. The proportion of patients with age ≥ 60 years and ferritin > 1500.0 ng/ml in the EBV-infected group was significantly higher than that in the non-infected group. The results of ROC analysis showed that the cut-off values of CRP, IgG, C3, C4, and CD56 cell counts to predict EBV infection were 13.2 mg/l, 12.5 g/l, 1.1 g/l, 0.6 g/l, 0.3 g/l, and 94.0 cells/µl. Multivariable logistic analysis showed that age ≥ 60 years old, CRP > 13.2 mg/l, BUN > 5.4 mmol/l, ferritin > 1500.0 ng/ml, IgG < 12.5 g/l, IgM < 1.1 g/l, C4 < 0.3 g/l, and CD56 cell counts > 94.0 cells/µl were the independent risk factors of EBV infection in SFTS patients.
SFTS combined with EBV infection is associated with high morbidity and mortality. It is necessary to strengthen screening for EBV infection and its early predictive markers after admission in SFTS patients.
在免疫功能低下的人群中，EB 病毒（EBV）可被重新激活并增殖，导致致命后果，但严重发热伴血小板减少综合征（SFTS）患者 EBV 感染的临床后果仍不确定。在本研究中，我们调查了 SFTS 患者 EBV 感染的感染率、影响因素和早期预测指标。
本回顾性研究纳入了 2011 年 5 月至 2021 年 8 月在南京医科大学第一附属医院治疗的 SFTS 患者，并将其分为感染组和非感染组。我们比较了两组患者的人口统计学特征、临床表现和体征、实验室检查和预后，并通过接受者操作特征（ROC）曲线和逻辑回归探讨了 EBV 感染的危险因素。
本研究共纳入 120 例接受 EBV-DNA 检测的住院 SFTS 患者。EBV 感染患者的死亡率有统计学显著升高（32.0% vs. 11.43%，P=0.005）。与非感染组相比，感染组的 C 反应蛋白（CRP）、肌酸激酶（CK）、空腹血糖（FBG）、血尿素氮（BUN）、D-二聚体和 CD56 细胞计数较高，免疫球蛋白 G（IgG）、IgM、补体 3（C3）和 C4 水平较低。感染组年龄≥60 岁和铁蛋白>1500.0ng/ml 的患者比例明显高于非感染组。ROC 分析结果显示，CRP、IgG、C3、C4 和 CD56 细胞计数的截断值分别为 13.2mg/l、12.5g/l、1.1g/l、0.6g/l、0.3g/l 和 94.0cells/µl。多变量逻辑分析显示，年龄≥60 岁、CRP>13.2mg/l、BUN>5.4mmol/l、铁蛋白>1500.0ng/ml、IgG<12.5g/l、IgM<1.1g/l、C4<0.3g/l 和 CD56 细胞计数>94.0cells/µl 是 SFTS 患者 EBV 感染的独立危险因素。
SFTS 合并 EBV 感染与高发病率和死亡率相关。有必要加强 SFTS 患者入院后的 EBV 感染筛查及其早期预测标志物。
