2006年广州地区登革热277例临床特征分析  

Clinical characteristics of 277 cases with dengue fever in Guangzhou during an epidemic of 2006

作　　者：王建[1] 洪文昕[1] 陈燕清[1] 贾卫东[1] 唐小平[1] 

机构地区：[1]广州市第八人民医院传染科,510060

出　　处：《中华全科医师杂志》2007年第1期38-41,共4页Chinese Journal of General Practitioners

摘　　要：目的探讨2006年7月至9月广州地区登革热患者的临床特点,提高临床医师对登革热的认识水平。方法对我院收治的277例登革热患者的临床资料进行回顾性分析,用 C6/36细胞进行血液登革病毒(DEV)分离,逆转录-聚合酶链反应(RT-PCR)与基因测序进行分型和鉴定。结果277例患者的年龄在9个月～78岁,平均36岁,男148例,女129例。主要临床表现为发热(100.0%)、皮疹(85.2%)、头痛(69.3%)、个身肌痛(51.3%)、骨痛(39.0%)、恶心呕吐(39.4%)。白细胞及血小板减少分别占75.5%和62.5%,血液生化 ALT 升高占59.6%,AST 升高占81.6%,低钾血症占53.8%。病原学检查登革病毒 IgM 阳性占90.6%,开始出现阳性的时间为病程的第3～10天,平均为6.2 d。20例患者的病毒培养液经 RT-PCR 和基因测序证实为登革病毒1型感染。临床分型均为典型登革热。结论此次广州地区流行的登节热为登革病毒1型所致。病例符合典型登革热的临床表现,肝损害较多,部分病例出现低钾血症,未出现登革出血热及登革休克综合征。患者经及时诊断和治疗,预后良好。Objective To explore the clinical and laboratory characteristics of patients with dengue fever （DF） in Guangzhou from July to September in 2006 and to improve the awareness of dengue virus infection for physicians. Methods Clinical data of 277 patients with DF admitted to our hospital in Guangzhou were retrospectively analyzed. Dengue virus was isolated from patients＇ blood specimens by C6/36 cell culture and typed by reverse transcriptase-polymerase chain reaction （RT-PCR） assay and gene sequencing. Results Age of the 277 patients, 148 males and 129 females, averaged 36 years with a standard deviation of 17 years, ranging from 9 months to 78 years. Their most common symptoms included fever （ 100. 0% ）, skin rash （ 85.2% ）, headache （ 69. 3%）, myalgia （51.3%）, bone soreness （39.0%） and nausea or vomiting （39. 4% ）, and leucopenia and thrombocytopenia occurred in 75.5% and 62.5% of them, respectively. Elevated alanine aminotransferase （ALT） was found in 59. 6%, elevated aspartate aminotransferase （AST） in 81.6%, and hypopotassemia in 53.8% of them. Serum positivity of antibody against dengue virus IgM was 90. 6%, which could be detected 3 to 10 days after onset of the illness, with a mean of 6. 2 days with a standard deviation of 1.9 days. Cell-cultured virus from 20 patients were identified as type-1 by RT-PCR and RNA sequence analyses. All patients were clinically classified as typical DF and all of them completely recovered. Conclusions DF during this epidemic in Guangzhou was caused by dengue virus-1, with typical manifestations in all the patients but more damage in the liver. Some patients demonstrated hypopotassemia, but no dengue hemorrhagic fever or dengue shock syndrome was found. All the patients experienced a good prognosis with timely diagnosis and treatment.

关 键 词：登革热 体征和症状 临床化学试验 回顾性研究 

分 类 号：R512.8[医药卫生—内科学]