2014年广州地区158例登革热住院患者临床特征分析  

Analysis of clinical characteristic of 158 inpatients with dengue fever in Guangzhou area during the 2014 epidemic

作　　者：叶子[1] 黄应雄[1] 蒋鹏[1] 郑梓煜[1] 熊艳[1] 徐嘉[1] 肖孝勇 詹红[1] 

机构地区：[1]中山大学附属第一医院急诊科,广东广州510080

出　　处：《中华危重病急救医学》2015年第4期300-305,共6页Chinese Critical Care Medicine

基　　金：广东省科技计划项目（20128061700086）;国家临床重点专科建设项目（2012-650）

摘　　要：目的：探讨登革热住院患者的临床特征，为登革热的临床诊治提供参考依据。方法回顾性分析2014年7月23日至10月31日广州地区登革热暴发期间，中山大学附属第一医院收治的158例登革热住院患者的病例资料，记录患者的一般资料、常规临床检查和病原学检查结果以及预后，并进行描述性统计分析。结果158例登革热住院患者平均年龄（56±20）岁，≥60岁者79例（占50.00%），男性94例（占59.49%）。①主要临床表现：发热（100%）、头痛（70.89%）、骨骼/肌肉疼痛（62.03%）、皮疹（54.43%）；部分患者有出血（25.95%）和血浆渗漏表现（14.56%）。②实验室检查：多数患者表现为白细胞总数降低（75.32%）、血小板减少（77.85%）、丙氨酸转氨酶（ALT）升高（57.59%）、天冬氨酸转氨酶（AST）升高（77.85%），但血细胞比容（HCT）增高者较少见（1.27%）。③病原学检查：急性期（起病0～5 d）血清登革热IgM抗体（DF-IgM）阳性率为63.54%（61/96），登革热病毒核酸（DENV-RNA）阳性率为92.62%（113/122）。④基础疾病：87例（占55.06%）合并基础疾病，最常见为高血压（27.22%）和2型糖尿病（15.82%）。⑤治疗措施：隔离患者直至病程超过5 d，且热退24 h以上，以对症支持治疗和及时防治各种并发症为主。⑥预后：重症登革热18例（占11.39%），其中1例死于消化道大出血，1例合并多器官功能障碍综合征（MODS）未愈出院，另有2例院内感染普通登革热患者死于原发心脑血管疾病，余154例（占97.47%）患者经对症支持治疗后均痊愈出院。结论本组登革热住院患者临床表现典型，且重症发生率较高。DENV-RNA检测是早期病原学诊断的敏感指标。经对症支持治疗大部分登革热患者预后良好，但对重症患者的早期识别和治疗干预方式仍需进一步研究。{Abstract}： ObjectiveTo investigate the clinical characteristics of the inpatients suffering from dengue fever in order to provide references for better diagnosis and treatment.Methods The clinical data of 158 dengue fever patients admitted to the First Affiliated Hospital of Sun Yat-Sen University from July 23rd to October 31st, 2014 during the 2014 epidemic in Guangzhou area were retrospectively analyzed, including general clinical manifestations, conventional examinations, pathogenesis, and prognosis.Results The mean age of the 158 patients was （56±20） years, with half of them over 60 years old （79 cases）. Among them, 94 （59.49%） were male.① The common manifestations included fever （100%）, headache （70.89%）, myalgia/bone soreness （62.03%）, and skin rash （54.43%）. Bleeding and plasma leakage were found in 25.95% and 14.56% of the patients respectively.② Laboratory examination：leucopenia （75.32%） and thrombocytopenia （77.85%） were found, and alanine aminotransferase （ALT） and aspartate aminotransferase （AST） were elevated in 57.59% and 77.85% of the patients respectively. However, elevation of blood hematocrit was rare （1.27%）.③ It was found that in the acute phase （0 - 5 days of the onset）, serum dengue virus antibody IgM （DF-IgM） was positive in 63.54% of the patients （61/96）, and 92.62% （113/122） of patients were dengue virus RNA （DENA-RNA） positive.④ The rate of comorbidity in this study was 55.06% （87/158）, including hypertension （27.22%） and type 2 diabetes （15.82%）, which were the two most common co-morbidities.⑤ All the patients were given supportive therapy to prevent complications. They were also isolated for more than 5 days after onset, and at least for 24 hours after subsidence of fever in addition.⑥ The criteria for the diagnosis of severe dengue were fulfilled in 18 patients （11.39%）. One patient died of massive hemorrhage from gastro-intestinal tract, and 1 patient voluntarily left hospital with u

关 键 词：登革热 临床特征 住院患者 

分 类 号：R512.8[医药卫生—内科学]