2019年汕头市登革热病例临床表现与病毒包膜蛋白分子特征研究

Study on clinical manifestations of cases of Dengue fever in Shantou City during 2019 and molecular characteristics of viral envelope protein

目的分析2019年汕头市登革热疫情中病例的临床表现以及实验室检测结果之间的相关性,为临床医生及检测人员对登革热病例的判定提供数据支持。方法回顾性分析患者就诊时的临床表现、核酸检测结果,根据患者的发病时间进行聚类分组,统计各个发病天数组中病例的临床表现及核酸检测呈阳性的比例;同时对2019年流行毒株的E基因进行序列测定,推导并比对分析包膜蛋白的氨基酸序列。结果临床表现中发热比例最大,为96.84%,眼眶痛比例最小,为8.99%;头痛及骨关节肌肉疼痛在早期的病例中比例较高,皮疹则在恢复期的病例中比例较高;核酸检测结果显示,在发病第7天阳性病例比例下降;流行毒株间有1~2个位点的氨基酸发生变异,但主要潜在毒力位点的氨基酸残基保持一致。结论 2019年登革热疫情中的病例临床表现以轻症为主,主要症状有:(1)头痛及骨关节肌肉疼痛,提示处于发病早期;(2)皮疹体征,提示处于恢复期。推定流行毒株属于弱毒株。

Objective To analyze the correlation between the clinical manifestations of the cases and laboratory detection results in the Dengue fever epidemic in Shantou City during 2019 so as to provide the data support for the judgment of the clinical doctors and laboratory detection personnel on the cases of Dengue fever.Methods The clinical manifestations and nuclear acid detection results when the patients visited to the hospital were retrospectively analyzed.The clustering grouping was conducted according to the onset time.The clinical manifestations of the cases in the onset days groups and ratio of nuclear acid detection positive results were statistically analyzed.Meanwhile,the E gene of the epidemic strains in 2019 conducted the sequence detection,and the amino acid sequence of the envelope protein was deduced and conducted the comparative analysis of amino acid sequence.Results The ratio of fever was maximal in the clinical manifestations,which was 96.84%,while the ratio of orbital pain was minimal,which was 8.99%;the proportion of headache and arthralgia in early cases were high,while the proportion of skin rash was high in convalescent cases;the result of nucleic acid detection showed that the proportion of positive cases was decreased on 7 d after the onset;there were 1-2 loci of amino acid mutation in the epidemic strains,but the amino acids of main potential toxicity loci remained the consistence.Conclusion The clinical manifestation in main cases of Dengue fever during 2019 epidemic was dominated by mild cases,the main symptoms were:(1)headache and arthralgia,which indicates that they are in the early stages of onset;(2)skin rash sign,indicating the recovery stage.The epidemic strains was presumed to belong to weakly toxic strains.