Objective To detect the serum viral load,lymphocyte subsets,serum enzymes and blood cell counts of severe fever with thrombocytopenia syndrome (SFTS) patients,and to use logistic regression analysis and receiver operating characteristic (ROC) curve to establish a model to analyze the severity of SFTS.Methods A case-control study of 24 SFTS cases admitted between May 2011 and July2012 was conducted at the First Affiliated Hospital of Nanjing Medical University.All SFTS cases were defined according to Fever with Thrombocytopenia Syndrome Prevention and Control Guidelines (2010 edition) issued by the Ministry of Health of the People's Republic of China.According to their disease severity,the patients were divided into two groups,the non-severe group (16 cases) and the severe group (8 cases).In addition,32 healthy volunteers were also enrolled in this study.Flow cytometry was adopted to detect the CD3 +,CD4 +,CD8 + lymphocytes and CD3-CD16 + CD56 + natural killer cells (NK cells) in the peripheral blood of SFTS patients,and cytometric beads array (CBA) was used to detect Th1/Th2/ Th17 cytokines.The serum viral load in patients with severe fever with thrombocytopenia syndrome virus (SFTSV) infection was detected by fluorescent quantitative PCR technology.Besides,white blood cells,platelets and serum enzymes were measured.The multi-index conjunctive model of logistic regression analysis and receiver operating characteristics (ROC) curve were used to analyze the predictive values of indexes on severity of SFTS.Results The ROC analysis of single index found that SFTSV RNA,CD3,CD4,CD8,CD56,AST,LDH,CK,IL-6 and IL-10 have good predictability on severity of SFTS in the early course of the disease ; the area under the curve (AUC) were 0.83,0.84,0.90,0.75,0.94,0.73,0.78,0.87,0.74 and 0.77 respectively,and the cut-off values of the SFTSV load,CD3 +,CD4 +,NK cells and CK were 6.19 log10 copies/ml,57.51％,19.47％,15.71％ and 696.45 U/L respectively.Using the step-by-step method logistic regression analysis to build a model and analyze the ROC curve of prediction probability,it was found that the predictability of joint indexes of SFTSV RNA/CD3/CD4/CD8/CD56,SFTSV RNA/ AST/lactate dehydrogenase (LDH)/CK,or SFTSV RNA/IL-6/IL-10 increases in a certain degree.The areas under the ROC curve were 0.95 (95 ％ CI:0.00-1.00),0.87 (95 ％ CI:0.75-0.99),and 0.83 (95 ％ CI:0.70-0.97),the sensitivities were 93.3％,86.70％ and 77.30％,and the specificities were 94.4％,83.30％ and 83.30％ respectively.Conclusions The level of serum SFTSV is highly related to the severity of the disease.The high levels of serum SFTSV load,LDH,CK,IL-6,and IL-10,together with significant reduction of CD3 + cells and CD4 + cells,may indicate poor prognosis of the SFTS patients.Based on the logistic regression model by multiple indexes,the severity of SFTS can be better predicted.

To investigate the clinical feature, risk factors and outcome of treatment in patients with liver failure complicated by invasive fungal infections.Retrospective analysis of the clinical data and related factors of 27 patients with liver failure complicated by invasive fungal infections was performed.These patients were admitted from January 2007 to August 2009 in our department.Among them, Candida albicans accounted for 17cases (54.84%), albicans tropicals for 4 cases (12.90%).Fungal infection in respiratory tract and alimentary tract accounted for 58.06% and 11% respectively.81.25% of them had fever fluctuating from 37.4 o C to 40 o C. 81.25% had elevated white blood cell counts .All had the usage of broad-spectrum of antibiotics, whereas some of them used corticosteroids and had invasive medical manipulation for the treatment.Most patients deteriorated after invasive fungal infections.21 cases accepted with the treatment of antifungal drugs and mortality rate was 63.00%.It was found that the invasive fungal infection possibility of patients with liver failure significantly increased.To prevent the occurrence of invasive fungal infection, promptly early treatment of liver failure, proper use of antibiotics, cautious use or disuse of corticosteroids, reduction of invasive medical manipulation should be well done.Early detection and treatment of fungal infection are vital to decrease in mortality rate.