登革热的临床特征分析和诊断体会

Clinical Characteristics and Diagnosis of Dengue Fever

目的总结登革热的临床特征和诊断体会,提高登革热的临床诊治技能。方法回顾性分析广州医科大学附属第一医院2014年6月—2016年10月诊治的650例登革热患者的临床资料,分析其中238例于发病第1、3、5天行血常规检查患者的白细胞计数、血小板计数变化规律。结果650例登革热患者的主要临床表现为发热(100.0%,650例)、乏力(96.2%,625例)、肌痛(89.1%,579例)、恶心(86.2%,560例)、畏寒(74.2%,482例)、皮疹(70.0%,392例)、腹泻(49.5%,322例)、呕吐(43.2%,281例)等。丙氨酸氨基转移酶(ALT)升高(49.4%,321例),天冬氨酸氨基转移酶(AST)升高(40.4%,263例),肌酸激酶(CK)升高(48.9%,318例),乳酸脱氢酶(LDH)升高(34.8%,226例),尿蛋白阳性(34.0%,221例)。238例患者发病第1、3、5天外周血白细胞计数减少者所占比例分别为4.2%(10例)、83.2%(198例)、92.9%(221例);血小板计数减少者所占比例分别为3.4%(8例)、15.1%(36例)、67.6%(161例)。结论近3年广州登革热患者临床表现以典型登革热症状为主,大部分患者白细胞计数减少开始出现于发病第3天,血小板计数减少开始出现于发病第5天;部分患者有肝、肾和肌肉损害。

Objective To study the clinical characteristics of dengue fever in order to provide a reference for the diagnosis and treatment of the disease. Methods Retrospective analysis of the clinical data of 650 cases of dengue fever patients in the First Affiliated Hospital of Guangzhou Medical University from June 2014 to October 2016. Two hundred and thirty-eight of them underwent the routine blood testing on the 1st,3rd and 5th days after the onset of the disease,the indexes included white blood count and platelet count change. Results Among the 650 cases,the common manifestations included fever [100. 0%（ 650/650） ],fatigue [96. 2%（ 625/650） ],myalgia [89. 1%（ 579/650） ],disgusting [86. 2%（ 560/650） ],chilly[74. 2%（ 482/650） ],skin rash [70. 0%（ 392/650） ],diarrhea [49. 5%（ 322/650） ],vomiting [43. 2%（ 281/650） ]; serological and biochemical testing found elevated alanine aminotransferase（ ALT） [49. 4%（ 321/650 ], elevated aspartate aminotransferase（ AST） [40. 4%（ 263/650） ],elevated creatine kinase（ CK） [48. 9%（ 318/650） ],elevated lactate dehydrogenase（ LDH） [ 34. 8%（ 226/650） ], and positive urine protein [34. 0%（ 221/650） ]. Out of the 238 cases,4. 2%（ 10/238） and 3. 4%（ 8/238） were found with leucopenia and thrombocytopenia,respectively by the 1st routine blood testing; 83. 2%（ 198/238） and 15. 1%（ 36/238） were found with leucopenia and thrombocytopenia,respectively by the 3rd routine blood testing; 92. 9%（ 221/238） and 67. 6%（ 161/238） were found with leucopenia and thrombocytopenia,respectively by the 5th routine blood testing. Conclusion Between June 2014 and October 2016,patients with dengue fever in Guangzhou presented the typical clinical characteristics of dengue fever; leukopenia and thrombocytopenia occurred in most of them on the 3rd and 5th days after the onset of the disease respectively; liver and kidney and muscle damage could be found in some of the patients.