广州市区疑似登革热643例临床特征分析

Retrospective study on clinical characteristics of 643 patients with suspected dengue in Guangzhou

目的分析2014年秋季广州市区登革热爆发性流行期间疑似病例的临床特点和实验室检查指标,为该疾病的诊断和防控提供依据。方法收集2014年9-11月在中山大学附属第一医院门诊就诊的广州市区登革热疑似病例,回顾统计病例的临床资料和实验室检查结果,分析描述其临床资料特点以及评价实验室检查筛查该疾病的诊断效能。结果入选疑似病例共643例,确诊登革热阳性466例。疑似病例中0~岁组81例,13~岁组385例,51~岁组177例,阳性率分别为42.0%、75.1%和80.8%。阳性患者均出现发热,其中单纯发热为69.7%,其次为合并呼吸道感染19.5%,合并皮疹以及合并消化道症状分别是6.7%和2.1%,出现白细胞降低、血小板降低和血细胞比容升高的比例分别为73.2%、33.3%和3.1%,均高于阴性组。诊断效能评估中,白细胞（WBC）、红细胞比容（HCT）和血小板（PLT）具有较高的阳性预测值（〉80%）,HCT对疾病的筛查价值较小。51~岁组WBC和PLT降低程度比其他年龄组更为明显。结论广州市区此次流行性登革热临床症状典型,WBC和PLT在筛查阳性病例上具有一定价值。中老年组的阳性率高于其他组,WBC和PLT降低程度更为明显,应该加强对这一人群的防控和临床诊治力度。

Objective This study is to analyze the clinical features and laboratory parameters of suspected dengue patients in our hospital during a dengue outbreak in Guangzhou at fall 2014,which is useful for the prevention and management of dengue and disease diagnosis. Methods Data of patients with suspected dengue was collected from September 2014 to November in our hospital. Clinical and laboratory data were retrospectively analyzed to describe the clinical characteristics of this outbreak and the diagnostic value of laboratory parameters. Results Totally 643 suspected cases were selected,including466 cases confirmed with dengue fever. In these cases,the positive rates of the 0~12 year age group,13~50 year age group and 51~ year age group were 42.0%,74.4% and 80.8%,respectively. The primary symptom of suspected patients was fever.In dengue patients with fever alone symptom were 69.7%,while fever combined with respiratory infections,merged rash and gastrointestinal symptoms were 19.5%,6.7% and 2.1%,respectively. The rates of leucopenia,thrombocytopenia,and elevated hematocrit ratio in dengue patients were 73.2%,33.3% and 3.1%,respectively,and were higher than those of the negative groups. WBC,HCT and PLT had a high positive predictive value（80%） in evaluating diagnostic efficiency of laboratory parameter for dengue. In 51~years old group,WBC and PLT were significantly decreased more than those of the other two groups. Conclusion This outbreak of dengue in Guangzhou has typical clinical symptoms. WBC and PLT have diagnostic value in screening the disease. In the older age group,the positive rate was significantly higher than those of other age groups and the decrease of WBC and PLT were more obvious,indicating that we should strengthen the prevention and management of this age group.