중증열성혈소판감소증후군 환자에 대한 특이 치료법의 비교 평가

Abstract

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an acute febrile illness resulting from infection with the severe fever with thrombocytopenia syndrome virus. Although the typical death rate for SFTS is said to be 20% or more, there is currently no viable treatment strategy in place for individuals with SFTS, and the majority of patients merely receive supportive care. The purpose of this study is to evaluate effective therapies that can improve mortality in patients with SFTS.

Methods: We collected information from 274 SFTS diagnosed patients and examined the therapeutic effects of antiviral drug (ribavirin), intravenous immunoglobulin, plasma exchange, and steroids, known as specific treatments for SFTS. Secondary infections accompanied after treatment were also analyzed.

Results: A significant increase in viral load was observed only in the steroid group among the four treatment methods including ribavirin, intravenous immunoglobulin, plasma exchange, and steroids. Only the steroid group revealed a statistically significantly greater mortality rate than the non-steroid group when the 30-day survival time was examined. Furthermore, only the steroid group experienced statistically significant increases in the frequency of secondary infections when compared to the plasma exchange or intravenous immunoglobulin groups. The intravenous immunoglobulin group demonstrated a drop in many inflammatory cytokines as a result of cytokine analysis in accordance with each treatment strategy, but no appreciable decrease in cytokines was seen in the other treatment alternatives. Rather, an increase in inflammatory cytokines such as TNF-a was observed in plasma exchange and steroid group.

Conclusion: The existence of effective treatments for SFTS is a powerful weapon to improve the patient’s survival rate. Among the several specific therapies provided so far, intravenous immunoglobulin may be proposed as an effective treatment for SFTS. However, caution should be exercised as steroids may increase the SFTS post-treatment mortality and secondary infection. This study proposes a scientific evidence-based treatment strategy for SFTS and contributes to the finding of effective candidate therapies.