McCormick J B, King I J, Webb P A, Scribner C L, Craven R B, Johnson K M, Elliott L H, Belmont-Williams R
N Engl J Med. 1986 Jan 2;314(1):20-6. doi: 10.1056/NEJM198601023140104.
In a study of Lassa fever in Sierra Leone, West Africa, we identified two variables associated with a high risk of death, and we evaluated the efficacy of ribavirin and Lassa virus-convalescent plasma for the treatment of Lassa fever. A serum aspartate aminotransferase level greater than or equal to 150 IU per liter at the time of hospital admission was associated with a case-fatality rate of 55 percent (33 of 60). Patients with the same risk factor who were treated for 10 days with intravenous ribavirin, begun within the first 6 days after the onset of fever, had a case-fatality rate of 5 percent (1 of 20) (P = 0.0002 by Fisher's exact test). Patients whose treatment began seven or more days after the onset of fever had a case-fatality rate of 26 percent (11 of 43) (P = 0.01). Viremia with levels greater than or equal to 10(3.6) TCID50 per milliliter on admission was associated with a case-fatality rate of 76 percent (35 of 46). Patients with this risk factor who were treated with intravenous ribavirin within the first six days after onset of fever had a case-fatality rate of 9 percent (1 of 11) (P = 0.006), whereas those treated after seven days or more of illness had a fatality rate of 47 percent (9 of 19) (P = 0.035). Oral ribavirin was also effective in patients at high risk of death. Lassa-convalescent plasma did not significantly reduce mortality in any of the high-risk groups. We conclude that ribavirin is effective in the treatment of Lassa fever and that it should be used at any point in the illness, as well as for postexposure prophylaxis.
在西非塞拉利昂进行的一项关于拉沙热的研究中，我们确定了两个与高死亡风险相关的变量，并评估了利巴韦林和拉沙病毒康复期血浆治疗拉沙热的疗效。入院时血清天冬氨酸氨基转移酶水平大于或等于每升150国际单位与55%的病死率相关（60例中有33例）。具有相同风险因素且在发热开始后6天内开始接受静脉注射利巴韦林治疗10天的患者，病死率为5%（20例中有1例）（通过Fisher精确检验，P = 0.0002）。发热开始后7天或更晚开始治疗的患者，病死率为26%（43例中有11例）（P = 0.01）。入院时病毒血症水平大于或等于每毫升10(3.6) 半数组织培养感染剂量与76%的病死率相关（46例中有35例）。具有此风险因素且在发热开始后6天内接受静脉注射利巴韦林治疗的患者，病死率为9%（11例中有1例）（P = \alpha），而在发病7天或更长时间后接受治疗的患者，病死率为47%（19例中有9例）（P = 0.035）。口服利巴韦林对高死亡风险患者也有效。拉沙康复期血浆在任何高风险组中均未显著降低死亡率。我们得出结论，利巴韦林对拉沙热治疗有效，应在疾病的任何阶段使用，以及用于暴露后预防。 （注：原文中“P = \alpha”处有误，推测可能是想表达“P = 0.006”，译文按修正后翻译）
