LASSA FEVER - EFFECTIVE THERAPY WITH RIBAVIRIN
LASSA FEVER - EFFECTIVE THERAPY WITH RIBAVIRIN
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DOI：
10.1056/nejm198601023140104
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发表时间：
1986-01-02
影响因子：
158.5
通讯作者：
BELMONTWILLIAMS, R
中科院分区：
文献类型：
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作者：
MCCORMICK, JB;KING, IJ;BELMONTWILLIAMS, R
在西非塞拉利昂的一项拉沙热研究中，我们确定了与高死亡风险相关的两个变量，并评估了利巴韦林和拉沙病毒恢复期血浆治疗拉沙热的疗效。血清天冬氨酸转氨酶水平≥入院时每升 150 IU 的病死率高达 55%（60 例中有 33 例）。具有相同危险因素的患者在发热后 6 天内开始静脉注射利巴韦林治疗 10 天，其病死率为 5%（20 人中的 1 人）（根据 Fisher 精确检验，P = 0.0002）。在发烧 7 天或更长时间后开始治疗的患者的病死率为 26%（43 例中的 11 例）（P = 0.01）。病毒血症水平为.gtoreq。入院时每毫升 103.6 TCID50 与 76% 的病死率相关（46 例中有 35 例）。具有这一危险因素的患者在发烧后的前 6 天内接受静脉注射利巴韦林治疗，其病死率为 9%（11 人中的 1 人）（P = 0.006），而在发病 7 天或更长时间后接受静脉注射利巴韦林治疗的患者的病死率为 47%（19 人中的 9 人）（P = 0.035）。口服利巴韦林对死亡高危患者也有效。拉沙恢复期血浆并未显着降低任何高危人群的死亡率。我们的结论是，利巴韦林可有效治疗拉沙热，并且应在疾病的任何阶段使用，以及用于暴露后预防。
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 .gtoreq. 150 IU per litre 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 .gtoreq. 103.6 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.