484例登革热临床实验诊断的分析  

Analysis of clinical laboratory diagnosis in 484 Dengue fever patients

作　　者：陈燕清[1] 唐小平[1] 关玉娟[1] 王建[1] 洪文昕[1] 卢业成[1] 张复春[1] 

机构地区：[1]广州市第八人民医院感染科,510060

出　　处：《中华检验医学杂志》2008年第1期82-85,共4页Chinese Journal of Laboratory Medicine

基　　金：2005年度广州市科技攻关计划重大项目资助（200521-E0111）

摘　　要：目的分析2006年广州地区484例登革热患者体检及实验室检查结果的特点。方法对入院患者进行常规检查，并收集急性期和恢复期血清进行病原学检查，分析统计各种临床症状、体征和检测项目结果的阳性例数及阳性率。所有患者确诊依据符合中华人民共和国卫生部颁布的《登革热诊断标准及处理原则》。结果本次登革热流行临床表现典型，以发热、头痛、全身酸痛、皮疹为多见。WBC减少368例（76．0％），PLT减少303例（62．6％），ALT升高270例（56．7％），AST升高400例（84．0％），223例（46．1％）的患者出现低钾血症。登革热病毒抗体IgM（DF—IgM）可在发病第1—16天内检测到，第8天内阳性率达85．9％。DF—IgM始终阴性的51例中7例急性期血清用实时荧光定量PCR检测病毒载量（DEVRNA）均阳性，结果为10^5～10^6拷贝／ml。结论2006年广州地区登革热流行患者临床表现典型，多数患者WBC、PLT减少明显，合并肝脏损害较多，肾脏损害表现较轻，近半数出现低钾血症。DF—IgM出现早，持续时间长，在发病7d内检测DF—IgM有助于登革热的早期诊断。实时荧光定量PCR检测DEV RNA可作为登革热早期病原学诊断的另一指标，且可以弥补抗体检测的不足。Objective To analyze the characteristics of laboratory test results of dengue fever（DF） patients in Guangzhou area.Methods Routine tests were performed in the patients admission to hospital. Serology examination was performed in the patients in acute phase or recovery phase. The clinical symptoms and features were analyzed and positive numbers and positivity ratios were calculated. Results The clinical symptoms of the dengue fever were typical, with the features of fever, headache, myalgia and rash. The leukopenia rate was 76. 0% , and the thrombocytopenia rate was 62. 6% . The levels of ALT increased in 56. 7% patients, and the levels of AST increased in 84.0% patients. Hypopotassemia was found in 46. 1% patients. Dengue virus antibody IgM （DF-IgM） was detected positive from the first day to the 16th day of the onset, and the positive rate was 85.9% on the 8th day. Virus loads were positive by fluorescence real-time PCR in seven acute serum samples（ within 3 days of the onset） of 51 cases whose DE-IgM were negative all the time, and the results was 10^5 - 10^6 copies/ml （ 〈 10^3 copies/ml means negative）. Conclusions Clinical manifestations of this DF epidemic were typical including fever, headache, myalgia and skin rash. Most of the patients had decreased leukocyte and thrombocyte obviously. Liver damage was common but kidney damage was seldom. Half of the patients got hypopotassemia. DF-IgM appeared in very early and persisted for a long time. The detection of DF-IgM within 7 days of the onset was helpful for diagnosis as early as possible. Viral load detected by real-time PCR could be another indicator of early pathogen diagnosis which provides complementation for antibody detection.

关 键 词：登革热 登革热病毒 免疫球蛋白M 聚合酶链反应 早期诊断 

分 类 号：R686[医药卫生—骨科学]