登革热伴出血与伴出疹患者实验室检查的特征分析  

Analysis on the laboratory features of patients with dengue fever in bleeding and in rash

作　　者：何惠达 李玉枝[1] 平岖[3] 洪文昕[2] 王建[2] 唐漾波[1] He Huida Li Yuzhi Ping Qu Hong Wenxin Wang Jian Tang Yangbo(Institute of Infectious Diseases, Guangzhou Eighth People ＇s Hospital, Guangzhou Medical University, Guangzhou 510060, China Department of lnfectious Diseases, Guangzhou Eighth People＇s Hospital, Guangzhou Medical University, Guangzhou 510060, China Department of Infectious Diseases, the Fifth Affiliated Hospital of Southern Medical University, Guangzhou 510900, China)

机构地区：[1]广州医科大学附属市八人民医院传染病研究所,510060 [2]广州医科大学附属市八人民医院感染科,510060 [3]南方医科大学第五附属医院感染科,广州510900

出　　处：《国际流行病学传染病学杂志》2017年第1期22-26,共5页International Journal of Epidemiology and Infectious Disease

摘　　要：目的分析比较2014年广东省登革热暴发流行期间登革热伴出血与登革热伴出疹患者的实验室检查特征。方法将广州市第八人民医院收治的51例登革热伴出血与151例登革热伴出疹的住院患者纳入研究，采用实时荧光PCR方法检测登革病毒（DENV）核酸，ELISA测定DENV的IgM和IgG抗体，流式细胞术检测CD3^＋／CD4^＋／CD8^＋淋巴细胞亚群；比较两组研究病例的实验室资料，并进行统计学分析。结果登革热伴出血患者的中性粒细胞、AST、血浆凝血酶原时间、活化部分凝血酶时间和尿蛋白阳性率分别为（56．77±19．11）×10^9L、80．00（45．00，109．00）U／L、13．40（12．85，13．95）S、47．50（42．90，53．20）S和44．7％，均高于登革热伴出疹患者，差异有统计学意义（t=2．591，Z=2．495、3．184、2．435，Х^2=9．786，P均〈0．05或〈0．01）；登革热伴出血患者的单核细胞、嗜酸性粒细胞、CD4^＋、CD8^＋、PLT、凝血酶原活动度和血浆纤维蛋白原分别为（9．79±4．96）×10^9L、[0．10（0．00，1．00）]×10^9L、372（220，585）个／μL、258（155，466）个／μL、[53．00（32．00，82．00）1×10^9／L、[93．55（86．57，102．66）]％和2．48（2．04，2．92）g/L，均低于登革热伴出疹患者，差异有统计学意义（t=-2．045，Z=-4．054、-1．962、-2．676、-3．806、-2．876和-2．111，P均〈0．05或〈0．01）。登革病毒IgM抗体阳性166例（83-42％），IgG抗体阳性33例（16．58％）。89例患者DENV核酸分型分析显示，DENV-1感染81例（91．01％），DENV．2感染3例（3．37％），DENV-1和DENV-2混合感染4例（4．49％），DENV-3感染1例（1．12％）。另外，51例登革热伴出血患者中重症登革热9例（17．65％），151例登革热发热伴出疹的患者中重症登革热2例（1．32％），差异有统计学意义（Х^2=16．684，P〈0．01）。结论2014年广东省登革热暴发Objective To analyze and compare the laboratory features of patients with dengue fever in bleeding and in rash during the dengue fever outbreak in Guangdong province in 2014, Methods A total of 51 patients with dengue fever in bleeding and 151 patients with dengue fever in rash in acute stage from Guangzhou Eighth People＇s Hospital were included. Dengue virus （DENV） RNA and genotyping were detected by real-time fluorescence PCR. Anti-DENV antibodies including IgM and IgG were dectected by ELISA. CD3^＋/CD4^＋/CD8^＋ T cell subpopulations were detected by flow cytometry. Laboratory data were collected and retrospectively analyzed. Results Neutrophil （NEU）, AST, prothrombin time （PT）, activated partial thromboplastin time （APTr） and positive rate of urine protein in patients with dengue fever in bleeding were （56.77±19.11）×10^9/L, 80.00（45.00,109.00） U/L, 13.40（12.85, 13.95） s, 47.50（42.90, 53.20） s and 44.7% ,which were all higher than those in rash with significant differences（t=2.591 ,Z= 2.495,3.184 and 2.435, Х^2=9.786,P all〈0.05 or〈0.01 ）. Monocyte, eosinophil, CD4^＋, CD8^＋, PLT, prothrombin time activity and fibrinogen in patients with dengue fever in bleeding were （9.79±4.96）×10^9/L, [0.10 （0.00,1.00）]×10^9/L, 372 （220,585） cell/μL,258 （155,466）cell/μL,[53.00 （32.00,82.00）]×10^9/L,[93.55 （86.57,102.66）]% and 2.48 （2.04,2.92） g/L, which were all lower than those in rash, with statistically significant differences （t=-2.045, Z= -4.054,-1.962,-2.676,-3.806,-2.876 and -2.111, P all 〈0.05 or 〈0.01 ）. A total of 166 （83.42%） cases were IgM positive and 33 （16.58%） cases were lgG positive. DENV genotyping detection among 89 patients showed that 81 （91.01%） cases were infected by DENV-1, 3（3.37%） cases by DENV-2, 4（4.49%） cases by DENV-1 and DENV-2, 1 （ 1.12% ） case by DENV-3. In addition, 9 （ 17.65% ） cases were diagnosed with severe dengue fever in bleeding（n= 51 ）, while 2 （1.32%） case

关 键 词：登革热 出血 出疹 实验室特征 

分 类 号：R512.8[医药卫生—内科学]