IVIG治疗发热伴血小板减少综合征的临床结局分析

IVIG Therapy for Severe Fever with Thrombocytopenia Syndrome: A Clinical Outcome Analysis

摘要: 目的：探讨静脉注射免疫球蛋白(IVIG)与发热伴血小板减少综合征(SFTS)患者临床结局之间的关联，为临床治疗提供参考依据。方法：纳入2021年4月至2023年12月于六安市人民医院住院的SFTS患者222例，进行单中心回顾性队列研究。收集患者人口学资料、实验室指标及治疗信息，以出院时临床状态为主要结局指标，分为“好转”与“未愈”。采用倾向性评分匹配平衡基线混杂因素，并在匹配前后分别构建多因素Cox比例风险模型，评估IVIG治疗与不良结局风险之间的关联。结果：222例患者中，IVIG治疗组87例，非IVIG组135例。经1:1最近邻匹配后，获得57对基线特征均衡的患者。多因素Cox回归分析显示，匹配前IVIG治疗的风险比(hazard ratio, HR)等于0.265 (P = 0.001)，匹配后风险比等于0.352 (P = 0.019)，均小于1。在逐步调整性别、年龄、基础疾病、炎症指标、感染及治疗等因素后，IVIG治疗与不良结局风险之间的负向关联方向保持一致(HR范围为0.334~0.417)，但在完全校正模型中统计学显著性有所减弱。结论：IVIG治疗与SFTS患者不良临床结局风险降低呈相关趋势。由于本研究为单中心回顾性设计，结论需前瞻性研究进一步验证。

Abstract: Objective: To investigate the association between intravenous immunoglobulin (IVIG) therapy and clinical outcomes in patients with severe fever with thrombocytopenia syndrome (SFTS), aiming to provide evidence for clinical management. Methods: This single-center retrospective cohort study enrolled 222 patients with SFTS hospitalized at Lu’an People’s Hospital from April 2021 to December 2023. Demographic data, laboratory parameters, and treatment information were collected. The primary outcome was clinical status at discharge, categorized as “improvement” or “non-recovery”. Propensity score matching (PSM) was employed to balance baseline confounders. Multivariate Cox proportional hazards models were constructed in both pre-match and post-match samples to evaluate the association between IVIG therapy and the risk of adverse outcomes. Results: Of the 222 patients, 87 received IVIG and 135 did not. After 1:1 nearest neighbor matching, 57 well-balanced pairs were obtained. Multivariate Cox regression analysis showed that IVIG therapy was associated with a reduced risk of adverse outcomes in both the pre-match (hazard ratio [HR] = 0.265, P = 0.001) and post-match (HR = 0.352, P = 0.019) samples. After sequential adjustment for sex, age, comorbidities, inflammatory markers, infection, and treatment-related factors, the direction of the negative association remained consistent (HR range: 0.334~0.417), although statistical significance was attenuated in the fully adjusted model. Conclusions: IVIG therapy showed a trend toward association with reduced risk of adverse clinical outcomes in patients with SFTS. Given the single-center retrospective design, these findings warrant validation in prospective studies.