红细胞分布宽度/白蛋白比值联合干扰素α、肿瘤坏死因子-α对发热伴血小板减少综合征患者预后的预测价值

doi:10.19871/j.cnki.xfcrbzz.2026.03.009

摘要/Abstract

摘要： 目的探讨红细胞分布宽度/白蛋白比值（red cell distribution width-to-albumin ratio, RAR）联合干扰素α（interferon-α, IFN-α）与肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）对发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome,SFTS）患者不良预后的早期预测价值。方法采用回顾性队列研究,连续纳入2023年6月至2025年8月南京市第二医院收治的396例SFTS患者,根据28d转归分为治愈组（304例）与预后不良组（92例）。收集患者入院时临床资料及实验室指标（包括RAR、IFN-α、TNF-α等）,通过单因素及多因素Logistic回归分析筛选独立危险因素,并采用受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）评估各指标及联合模型的预测效能。结果预后不良组年龄、RAR、病毒载量、TNF-α、IFN-α、总胆红素（total bilirubin,TBIL）、葡萄糖、尿素氮（blood urea nitrogen,BUN）水平均显著高于治愈组（均P<0.05）。多因素Logistic回归分析显示,上述指标均为SFTS患者不良预后的独立危险因素（均OR>1,均P<0.05）。ROC曲线分析表明,RAR、TNF-α、IFN-α单独预测的曲线下面积（area under curve,AUC）分别为0.762、0.582、0.762;三者联合预测的AUC提升至0.864（95%CI：0.832~0.896）,敏感度为72.8%,特异度为86.5%,预测性能显著优于单一指标。结论 RAR、IFN-α与TNF-α升高是SFTS患者不良预后的危险因素。三者联合构建的预测模型具有较好的判别能力,可为早期识别高危患者、实施分层干预提供有价值的参考。

关键词: 发热伴血小板减少综合征, 红细胞分布宽度/白蛋白比值, 干扰素α, 肿瘤坏死因子-α, 预后

Abstract: Objective To evaluate the predictive value of the red cell distribution width-to-albumin ratio (RAR) combined with interferon-α(IFN-α) and tumor necrosis factor-α(TNF-α) for early identification of poor prognosis in patients with severe fever with thrombocytopenia syndrome (SFTS). Method A retrospective cohort study was conducted, enrolling 396 SFTS patients admitted to Nanjing Second Hospital between June 2023 and August 2025. Based on 28-day outcomes, patients were categorized into a cured group (n=304) and a poor prognosis group (n=92). Clinical data and laboratory parameters (including RAR, IFN-α, and TNF-α) collected at admission were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. The predictive performance of individual indicators and a combined model was assessed using receiver operating characteristic (receiver operator characteristic curve, ROC) curve analysis. Result The poor prognosis group had significantly higher levels of age, RAR, viral load, TNF-α, IFN-α, total bilirubin (TBIL), glucose (GLU), and blood urea nitrogen (BUN) compared to the cured group (all P<0.05). Multivariate analysis confirmed these indicators as independent risk factors for poor prognosis (all P<0.05). ROC analysis showed that the areas under the curve (AUC) for RAR, TNF-α, and IFN-α alone were 0.762, 0.582, and 0.762, respectively. The AUC for the combined model increased to 0.864 (95%CI: 0.832-0.896), with a sensitivity of 72.8% and a specificity of 86.6%, demonstrating superior predictive performance compared to any single indicator. Conclusion RAR, IFN-α, and TNF-α are independent risk factors for poor prognosis in SFTS patients. The combined prediction model incorporating these three indicators shows good discriminative ability and may serve as a valuable tool for the early identification of high-risk patients, facilitating stratified clinical management.

Key words: Severe fever with thrombocytopenia syndrome, Red cell distribution width-to-albumin ratio, Interferon-α, Tumor necrosis factor-α, Prognosis

中图分类号:

R512.91
R373

张雪辰, 方明霞, 江浩, 卢虎. 红细胞分布宽度/白蛋白比值联合干扰素α、肿瘤坏死因子-α对发热伴血小板减少综合征患者预后的预测价值[J]. 新发传染病电子杂志, 2026, 11(3): 49-54.

Zhang Xuechen, Fang Mingxia, Jiang Hao, Lu Hu. The predictive value of red cell distribution width-to-albumin ratio combined with interferon-α and tumor necrosis factor-α for prognosis in patients with fever with thrombocytopenia syndrome[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(3): 49-54.

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