2013年至2019年广东省重症登革热患者的临床特征分析  

Clinical features of patients with severe dengue in Guangdong Province from 2013 to 2019

作　　者：洪文昕[1] 王长泰 赵令斋[2,13] 谢冬英[3] 刘南[4] 陈仁[5] 王建[1] 叶一农[6] 林树强[7] 赵子文[8] 叶晓光[9] 彭劼[10] 高文军 杨慧勤[1] 李粤平[1] 李凌华[1] 蔡卫平[1] 张复春[1] 唐小平[12] Hong Wenxin;Wang Changtai;Zhao Lingzhai;Xie Dongying;Liu Nan;Chen Ren;Wang Jian;Ye Yinong;Lin Shuqiang;Zhao Ziwen;Ye Xiaoguang;Peng Jie;Gao Wenjun;Yang Huiqin;Li Yueping;Li Linghua;Cai Weiping;Zhang Fuchun;Tang Xiaoping(Department of Infectious Diseases,Guangzhou Eighth People′s Hospital,Guangzhou Medical University,Guangzhou 510060,China;Institute of Infectious Diseases,Guangzhou Eighth People′s Hospital,Guangzhou Medical University,Guangzhou 510060,China;Department of Infectious Diseases,The Third Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510630,China;Emergency Department,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Infectious Diseases,Guangdong Provincial People′s Hospital,Guangzhou 510080,China;Department of Infectious Diseases,The First People′s Hospital of Foshan,Foshan 528000,China;Department of Infectious Diseases,Chaozhou Central Hospital,Chaozhou 521011,China;Department of Pulmonary and Critical Care Medicine,Guangzhou First People′s Hospital,Guangzhou 510180,China;Department of Infectious Diseases,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou;510260,China Department of Infectious Diseases,Nanfang Hospital of Southern Medical University,Guangzhou 510515,China;Department of Infectious Diseases,Zhongshan Second People′s Hospital,Zhongshan 528447,China;Guangzhou Medical University,Guangzhou 511436,China;Department of Clinical Laboratory,Guangzhou Eighth People′s Hospital,Guangzhou Medical University,Guangzhou 510060,China)

机构地区：[1]广州医科大学附属市八医院感染病中心,广州510060 [2]广州医科大学附属市八医院传染病研究所,广州510060 [3]中山大学附属第三医院感染科,广州510630 [4]广州中医药大学第一附属医院急诊科,广州510405 [5]广东省人民医院感染科,广州510080 [6]佛山市第一人民医院感染科,佛山528000 [7]潮州市中心医院感染科,潮州521011 [8]广州市第一人民医院呼吸内科,广州510180 [9]广州医科大学附属第二医院感染科,广州510260 [10]南方医科大学南方医院感染科,广州510515 [11]中山市第二人民医院感染科,中山528447 [12]广州医科大学,广州511436 [13]广州医科大学附属市八医院检验科,广州510060

出　　处：《中华传染病杂志》2022年第6期328-334,共7页Chinese Journal of Infectious Diseases

基　　金：广东省科技专项资金(2013A020229001);广州市健康医疗协同创新重大计划项目(201508020263、201803040006)。

摘　　要：目的:分析广东省重症登革热(severe dengue,SD)患者的临床特征,提高对中国SD的诊治认识。方法:纳入2013年1月1日至2019年12月31日来自广东省29家登革热定点收治医院的257例SD患者,采集临床资料、实验室检查和病原学检测结果,量化严重器官损伤判定标准的相关指标。采用logistic回归分析SD患者发生多器官功能衰竭的危险因素。结果:257例SD患者的年龄为(64.1±20.1)岁,60岁及以上占65.4%(168/257);男142例,女115例。152例(59.1%)患者合并基础疾病,其中高血压115例(44.7%)。临床表现主要为发热[98.4%(253/257)]、乏力[70.0%(180/257)]、咳嗽或咳痰[44.4%(114/257)]、嗜睡或烦躁[39.3%(101/257)]、呕吐[30.4%(78/257)]、腹痛或压痛[20.6%(53/257)]、肝大[2.3%(6/257)]、出血倾向[59.5%(153/257)]、胸腔积液或腹水[43.6%(112/257)]。90.9%(231/254)的患者血小板计数降低,97.1%(234/241)的患者血细胞比容正常或降低。重症表现中出现严重器官损伤最多[61.1%(157/257)],其次为严重出血[37.0%(95/257)]、严重血浆渗漏[30.0%(77/257)];严重器官损伤以肾脏[27.6%(71/257)]、心脏[26.8%(69/257)]损伤多见。多因素logistic回归分析显示,年龄[比值比(odds ratio, OR)=1.051,95%可信区间(confidence interval, CI)1.004~1.100, P=0.035],合并高血压( OR=5.224,95% CI 1.272~21.462, P=0.022),天冬氨酸转氨酶( OR=1.002,95% CI 1.001~1.003, P=0.001)、血尿素氮( OR=1.050,95% CI 1.005~1.098, P=0.030)和国际标准化比值( OR=4.604,95% CI 1.601~13.238, P=0.005)水平升高为SD患者发生多器官功能衰竭的危险因素。113例SD患者的急性期血清样本检测结果显示,登革病毒-1型占89.4%(101/113),登革病毒-2型占9.7%(11/113),登革病毒-3型占0.9%(1/113)。 结论:广东省SD患者以老年与合并高血压等基础疾病者多见,肾脏、心脏等器官严重损伤多见,登革病毒-1型感染为主。天冬氨酸转氨酶、血尿素氮和国际标准化比值水平升高与不良预后相关。Objective To analyze the clinical features of patients with severe dengue(SD)in Guangdong Province,and to improve the understanding of the diagnosis and treatment of SD in China.Methods The clinical data,laboratory examination and etiological test results of 257 SD cases from 29 dengue fever designated hospitals in Guangdong Province from January 1,2013 to December 31,2019 were respectively collected.The relevant indicators of the criteria for severe organ involvement were quantified.Logistic regression analysis was performed to analyze the risk factors for the development of multiple organ failure in SD patients.Results Among the 257 SD patients,age was(64.1±20.1)years old,with 65.4%(168/257)of them≥60 years old,142 were male and 115 were female.One hundred and fifty-two(59.1%)patients had underlying conditions,including 115(44.7%)patients with hypertension.The clinical manifestations were mainly fever(98.4%(253/257)),fatigue(70.0%(180/257)),cough or expectoration(44.4%(114/257)),lethargy or irritability(39.3%(101/257)),vomiting(30.4%(78/257)),abdominal pain or tenderness(20.6%(53/257)),hepatomegaly(2.3%(6/257)),bleeding tendency(59.5%(153/257)),and pleural effusion or ascites(43.6%(112/257)).Platelet count levels were decreased in 90.9%(231/254)of the cases,and 97.1%(234/241)of patients had normal or decreased hematocrit.The most common of severe manifestations were severe organ involvement(61.1%(157/257)),followed by severe bleeding(37.0%(95/257))and severe plasma leakage(30.0%(77/257)).Severe organ involvements were more common in the kidney(27.6%(71/257))and heart(26.8%(69/257)).Multivariate logistic regression analysis showed that age(odds ratio(OR)=1.051,95%confidence interval(CI)1.004 to 1.100,P=0.035),hypertension(OR=5.224,95%CI 1.272 to 21.462,P=0.022),elevated aspartate aminotransferase(AST)level(OR=1.002,95%CI 1.001 to 1.003,P=0.001),blood urea nitrogen(BUN)(OR=1.050,95%CI 1.005 to 1.098,P=0.030),and international normalized ratio(INR)(OR=4.604,95%CI 1.601 to 13.238,P=0.005)were risk factors for th

关 键 词：登革热 严重登革热 临床特征 器官损伤 

分 类 号：R512.99[医药卫生—内科学] R373.33[医药卫生—临床医学]