Clinical Characteristics Of Cytokine Levels In Patients With Severe Fever With Thrombocytopenia Syndrome

BackgroundSevere fever with thrombocytopenia syndrome(SFTS)is an emerging infectious disease,which is widely distributed in 23 provinces of China’s mainland and other Asian countries,severe fever with thrombocytopenia syndrome bunyavirus(SFTSV)is its pathogenic pathogen.In recent years,the prevalence of SFTS in Shandong has gradually increased.As a new infectious disease,its pathogenesis,disease occurrence and development,treatment strategies and other aspects have not yet been clarified,making it a public health event that seriously threatens the health of people around the world.Currently,there are few studies on the correlation between SFTS cytokine levels and disease severity,this study detects the cytokine levels of SFTS patients with different disease conditions and analyzes the correlation with related laboratory indicators,and monitors the dynamic trend of cytokines after the onset of disease,this topic has important scientific and practical significance for revealing the immune damage and pathogenic mechanism of SFTSV,guiding clinical treatment,reducing mortality,etc.ObjectivesTo explore the cytokine levels of SFTS patients with different conditions and their dynamic changes with the progress of the disease,provide experimental basis for clinicians to predict the severity of SFTS,further revealing the role of cytokines in the development of disease,clarifying the immune injury and pathogenesis of SFTSV.MethodsSFTS patients treated in Jinan Infectious Diseases Hospital from June 2019 to October 2019 were collected as the research objects.According to the progress of the disease,they were divided into severe group and mild group.In addition,community healthy persons from Jinan Infectious Diseases Hospital were collected as the control group,collect their serum samples.Quantitative detection of cytokines levels with flow cytometry and carrying out correlation analysis with some laboratory indicators,and dynamic monitoring of cytokines in 24 SFTS patients.Independent sample t test is used for measurement data of normal distribution,Non-parametric test is used for skewness distribution,and chi-square test is used for counting data;the correlation between serum cytokines and laboratory indexes of SFTS patients was detected by Spearman correlation analysis.P<0.05 indicates that the difference is statistically significant.Results1.A total of 78 SFTS patients(37 males)and 60 community healthy persons(21 males)were collected,The serum levels of IL-6,IL-10 and IFN-α in the patient group were significantly higher than those in the control group(P=0.000、0.000、0.000,respectively),but the levels of IL-2,IL-4 and TNF-α in the patient group compared with the control group,the difference was not Statistically significant(P=0.226、0.603、0.951,respectively).2.Among the 78 SFTS patients,there were 18 patients in the severe group(13 males)and 60 patients in the mild group(24 males).The levels of serum IL-6,IL-10,TNF-α,and IFN-α in the severe group were higher than those in the mild group,and the differences were statistically significant(P=0.002、0.000、0.028、0.035,respectively),while the levels of serum IL-2 and IL-4,there was no statistically significant difference between the two groups(P=0.184、0.136,respectively).3.During the monitoring period,with the progress of the treatment of SFTS patients,it can be seen that the levels of the 6 cytokines detected in this study increased first and then decreased.Among them,serum IL-10 changed significantly between 3,7and 11 days.The differences between the 3th and 7th days and the 7th and 11th days were statistically significant(P1<0.05,P2<0.05),suggesting that as the treatment progresses and the condition improves,IL-10 levels gradually decrease.Serum IL-2,IL-4,IL-6,TNF-α,IFN-a levels all showed a rising trend on the 7th day,and gradually decreased on the 11th day as the condition improved,and the differences in their levels were statistically significant(all P2<0.05).4.The differences in some laboratory indicators between the severe group and the mild group of SFTS patients were statistically significant.Detection results showed ALT(Z=2.984),AST(Z=3.680),LDH(Z=3.549),and CK(Z=3.332),blood sugar(Z=2.984),APTT(t=-5.086),TT(t=-3.237)levels of the severe group were significantly higher than the mild group(P=0.003、0.000、0.000、0.001、0.003、0.006、0.002,respectively),while PLT count(t=3.771),blood sodium(t=2.250),blood calcium(t=5.072)levels of the severe group were significantly lower than the mild group(P=0.000、0.027、0.000,respectively).Correlation analysis results showed that serum IL-2 was positively correlated with AST,LDH,CK,APTT,TT(r=0.366、0.270、0.408、0.326、0.273,respectively),and negatively correlated with PLT and blood calcium(r=-0.248、-0.254,respectively);serum IL-4 was positively correlated with AST(r=0.225),negatively correlated with serum sodium(r=-0.244);serum IL-6 was positively correlated with LDH(r=0.281),and negatively correlated with PLT and blood calcium(r=-0.253、-0.273,respectively);serum IL-10 was positively correlated with AST,LDH,CK,APTT,TT(r=0.266、0.391、0.426、0.379、0.289,respectively),and negatively correlated with WBC,PLT,and blood calcium(r=-0.330、-0.477、-0.536,respectively);serum TNF-α and AST,LDH,CK,APTT were positively correlated(r=0.316、0.272、0.248、0.318,respectively);serum IFN-αwas positively correlated with CK and APTT(r=0.258、0.311,respectively),and negatively correlated with WBC,PLT,blood sodium,and blood calcium(r=-0.506、-0.236、-0.236、-0.284,respectively).Conclusions1.The levels of serum IL-6,IL-10,TNF-α and IFN-α can reflect the severity of the SFTS patient’s condition,the higher the level of cytokines,the more serious the damage of each organ.2.The cytokine level of SFTS patients changes dynamically,and the levels of related cytokines increased or decreased in varying degrees with the progress of the disease.