福州市403例登革热病例的流行病学及临床特征分析

The epidemiological and clinical features of 403 cases with dengue fever in Fuzhou City

目的 分析403例福州市登革热病例的流行特征及临床特点,给登革热防控与诊治工作提供指导.方法 采用回顾性分析研究方法,对福建医科大学孟超肝胆医院2016年7月至11月收治的403例福州市本地登革热病例的流行病学资料、临床特点、实验室检查、治疗及转归等进行收集整理和分析.结果 年龄≤20岁56例（13.89％）,21～50岁160例（39.71％）,〉50岁187例（46.40％）.8至10月进入登革热发病高峰期（94.29％）.临床分型以典型登革热为主（98.01％）.大多数病例急骤起病,主要临床症状包括发热391例（97.02％）、全身酸痛355例（88.09％）、皮疹156例（38.71％）等.全部患者在发病初期进行登革病毒血清学及病原学检测,其中NS1抗原阳性率95.04％,IgM抗体阳性率13.90％ 、IgG抗体阳性率8.19％;血小板计数减少332例（82.38％）,中性粒细胞计数减少293例（72.70％）,白细胞计数减少274例（67.99％）;AST升高256例（63.52％）,ALT升高146例（36.23％）,CK升高130例（32.26％）,PT延长40例（9.93％）;肺部CT发现双肺斑条影、炎性病灶等异常289例（82.75％）,胸腔积液25例（6.20％）;彩色多普勒超声发现肝肿大46例（11.41％）,脾肿大84例（20.84％）,少量腹水8例（1.99％）.结论 403例登革热病例大部分临床表现典型,主要影响血液系统、肝脏、心脏、肺脏、肾脏、骨骼肌系统、免疫系统等.临床医师应仔细观察病情,掌握重症登革热预警指征,做好重症病例的早期识别和及时救治,从而降低病死率.

Objective To analyze the epidemiological and clinical characteristics of 403 local cases with dengue fever , and to provide guidance for dengue fever＇s prevention , diagnosis and treatment . Methods The epidemical data ,clinical characteristics ,laboratory results ,therapy and outcomes of 403 cases with dengue fever treated in Mengchao Hepatobiliary Hospital of Fujian Medical University ,Fuzhou from July to November 2016 were collected and analyzed retrospectively .Results Among the 403 cases , 56 cases （13 .89% ） were younger than 20 years old ,160 cases （39 .71% ） were 21 to 50 years old ,and 187 cases （46 .40% ） were over 50 years old .The peak incidence period of dengue fever was from August to October ,accounting for 94 .29% of the cases .The clinical classification was dominated by typical dengue fever （98 .01% ） .Most of the cases had sudden onset .The main clinical symptoms included fever in 391 cases （97 .02% ） , body aches in 355 cases （88 .09% ） , and rash in 156 cases （38 .71% ） . All patients were tested for serology and etiology of dengue virus at the early stage of disease .Among them , the positive rate of NS1 antigen was 95 .04% ;the positive rate of IgM antibody was 13 .90% ,and the positive rate of IgG antibody was 8 .19% . Thrombocytopenia was founded in 332 cases （82 .38% ） .Neutrophil count decreased in 293 cases （72 .70% ） , w hite blood cell count decreased in 274 cases （67 .99% ） .Aspartate aminotransferase increased in 256 cases （63 .52% ） and alanine aminotransferase increased in 146 cases （36 .23% ） .Creatine kinase elevated in 130 cases （32 .26% ） and prothrombin time was prolonged in 40 cases （9 .93% ） .A total of 289 cases （82 .75% ） had bilateral lesions in both lungs and 25 cases （6 .20% ） had pleural effusions . Color doppler ultrasound found 46 cases （11 .41% ） of hepatomegaly ,84 cases （20 .84% ） of splenomegaly ,8 cases （1 .99% ） of a small amount of ascites . Conclusions Most of the 403 cases of dengue fever show typical clinical manifestations .Dengue fever mainly affects the blood system ,liver ,heart ,lung ,kidney ,skeletal muscle system ,and immune system . Clinicians should carefully observe the condition ,master the warning signs of severe dengue fever ,and achieve early identification and timely treatment of severe cases ,thereby reducing the mortality rate .