比较发热伴血小板减少综合征（SFTS）与恙虫病患者症状、实验室指标及预后转归。

收集武汉大学中南医院感染科2025年4月至6月收治的33例SFTS和17例恙虫病患者的人口学与临床特征（性别、年龄、职业、临床表现、实验室以及影像学检查结果）。观察患者自入院至第28 d病情变化及转归，记录死亡患者从发病到死亡的生存时间。使用大别班达病毒核酸、靶向二代宏基因组测序技术（tNGS）检测方法进行诊断；SFTS和恙虫病患者分别接受法维拉韦和奥马环素治疗。两组患者计量资料比较采用独立样本t检验或秩和检验，计数资料比较采用Fisher’s确切概率法。应用Kaplan-Meier法分析患者生存时间，采用log-rank检验比较患者生存过程。

入组SFTS与恙虫病患者均为农民，性别（P=0.327）和发病年龄（t=1.673、P=0.101）差异均无统计学意义。临床表现：两组患者发热表现差异无统计学意义（P=1.000）。较恙虫病患者，SFTS患者出血（39.4% vs. 0.0%：P=0.002）和神经系统累及（51.5% vs. 0.0%：P＜0.001）比例显著升高；而皮疹（9.1% vs. 88.2%：P＜0.001）、焦痂（0% vs. 29.4%：P=0.003）、肌肉酸痛（33.3% vs. 64.7%：P=0.042）比例显著降低，差异均有统计学意义。影像学表现：两组患者均有肺部感染（P=0.129）、肝脾肿大（P=0.597）与淋巴结肿大（P=0.099），但差异无统计学意义（Fisher’s确切概率法）。33例SFTS患者中22例好转出院，11例死亡；有15例（45.5%）患者入住ICU，转ICU后有6例行气管插管，均死亡。17例恙虫病患者均临床治愈出院，无病例入住ICU。Log-rank检验结果显示，恙虫病患者较SFTS患者生存率更高，差异有统计意义（χ²=6.79、P=0.009）。较恙虫病患者，SFTS患者白细胞（Z=4.07、P＜0.001）和血小板计数（Z=5.04、P＜0.001）显著下降，丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酸激酶同工酶、乳酸脱氢酶、淀粉酶以及肌钙蛋白水平显著升高（P均＜0.05），活化部分凝血活酶时间（Z=4.62、P＜0.001）和凝血酶时间（Z=4.92、P＜0.001）显著延长，差异均有统计学意义。

SFTS患者多表现为出血、神经系统累及，且病死率高。恙虫病患者实验室检查多为轻度异常，脏器损伤较轻。医生对有流行病学史且表现为皮疹+焦痂+肌肉酸痛，疑诊恙虫病的患者，优先经验性给予四环素类抗菌药物，有利于病情快速控制，减少并发症，改善预后。

To compare the symptoms, laboratory indicators and prognostic outcomes between patients of fever with thrombocytopenia syndrome (SFTS) and scrub typhus.

The demographic and clinical characteristics (gender, age, occupation, clinical manifestations, laboratory test results and imaging examination results) of 33 patients with SFTS and 17 patients with scrub typhus admitted to the Department of Infectious Diseases, Zhongnan Hospital of Wuhan University from April to June 2025 were collected. The condition changes and outcomes of the patients from admission to day 28 were observed, while the survival time from onset to death of deceased patients were recorded. The cases were diagnosed by the nucleic acid of Dabie bandavirus and targeted next-generation sequencing detection methods. Patients with SFTS and scrub typhus were treated with favipiravir and omalizumab, respectively. Comparisons of quantitative data were performed by the independent samples t-test or rank sum test, while count data was analyzed by Fisher’s exact probability method. Survival period was analyzed by the Kaplan-Meier method, and survival processes were compared by log-rank test.

All patients with SFTS and scrub typhus were farmers, with no statistically significant differences in gender (P=0.327) or age at onset (t=1.673, P=0.101). Clinical manifestations: patients of both groups exhibited fever, but without statistically significant difference (P=1.000). Compared with patients of scrub typhus, the proportions of bleeding (39.4% vs. 0.0%: P=0.002) and neurological involvement (51.5% vs. 0.0%: P<0.001) of patients with SFTS were significantly higher, while the proportions of patients with rash (9.1% vs. 88.2%: P<0.001), eschar (0% vs. 29.4%: P=0.003) and muscle pain (33.3% vs. 64.7%: P=0.042) were significantly lower, all with significant differences. The differences of imaging examinations revealed pulmonary infection (P=0.129), hepatosplenomegaly (P=0.597) and lymphadenopathy (P=0.099) between the two groups were not statistically significant (by Fisher’s exact test). Among the 33 patients with SFTS, 22 were discharged after improvement and 11 died; 15 patients (45.5%) were admitted to ICU, and 6 of them underwent tracheal intubation after admission to ICU, all of whom died. All 17 patients with scrub typhus were clinically cured and discharged, and none were admitted to ICU. Log-rank test showed that the survival rate of patients with scrub typhus was higher than that of patients with SFTS, with significant difference (χ²=6.79, P=0.009). Compared with patients with scrub typhus, the counts of white blood cells (Z=4.07, P<0.001) and platelet (Z=5.04, P<0.001) were significantly decreased in patients with SFTS, while alanine aminotransferase, aspartate aminotransferase, creatine kinase isoenzyme, lactate dehydrogenase, amylase and troponin levels were significantly elevated (all P<0.05), the activated partial thromboplastin time (Z=4.62, P<0.001) and thrombin time (Z=4.92, P<0.001) were prolonged, all with significant differences.

Patients with SFTS often present hemorrhage and neurological involvement, and a high mortality rate. Laboratory tests of patients with scrub typhus mostly show mild abnormalities, with relatively minor organ damage. For patients with epidemiological history presenting rash + eschar + myalgia and suspected SFTS, empirical administration of tetracyclines is prioritized, which facilitates rapid disease control, reducing complications and improving the prognosis.