中国登革热变化趋势:重症合并率与临床表现Meta分析

Changing trends of dengue fever in China:Meta-analysis of comorbidity rates and clinical manifestations

目的分析中国成人和儿童重症登革热(severe dengue,SD)的变化趋势,并比较2类人群间临床表现差异,为优化登革热防控策略和减少重症病例提供科学依据。方法通过关键词检索中国知网、万方、维普、Scopus数据库建库至2023年12月31日发表的登革热临床或感染相关文献,根据预设的纳入排除标准筛选文献,采用R 4.2.3软件进行Meta分析。结果共检索到7148条记录,最终纳入成人30项研究和儿童12项研究,涉及8个省份。成人登革热重症合并率从1978—1995年的6.6%降至2014—2023年的0.9%,儿童从1980—1995年的15.8%大幅降至2014—2019年的0.5%。成人主要临床表现合并率为发热99.2%、肌肉疼痛55.6%、头痛52.0%、皮疹45.5%、疲乏34.4%;儿童主要临床表现合并率为发热97.6%、头痛38.8%、纳差31.9%、皮疹30.5%、淋巴结肿大20.5%。结论近年来,成人和儿童登革热重症合并率均显著下降,表明我国登革热防控策略取得了显著效果。成人突出临床表现为器官损害,儿童突出临床表现为消化道症状。未来应加强早期诊断和规范化治疗,以进一步降低登革热的临床危害。

Objective To analyze the changing trends of severe dengue(SD)among adults and children in China and compare the clinical manifestations between the two groups,providing scientific evidence to optimize dengue prevention strategies and reduce severe cases.Methods Literature related to clinical or infection aspects of dengue fever clinical or infection studies published from database inception to December 31,2023,were retrieved from CNKI,Wanfang,VIP,and Scopus databases using keyword searches.The literature was screened according to predefined inclusion and exclusion criteria,and a meta-analysis was conducted using R(4.2.3)software.Results A total of 7148 records were retrieved,ultimately including 30 studies on adults and 12 studies on children,involving eight provinces.The severe dengue comorbidity rate in adults decreased from 6.6%during 1978-1995 to 0.9%during 2014-2023,while in children,it significantly dropped from 15.8%during 1980-1995 to 0.5%during 2014-2019.In adult studies,the primary clinical manifestations and their comorbidity rates were:fever(99.2%),myalgia(55.6%),headache(52.0%),rash(45.5%),and fatigue(34.4%).In pediatric studies,the primary clinical manifestations and their comorbidity rates were:fever(97.6%),headache(38.8%),anorexia(31.9%),rash(30.5%),and lymphadenopathy(20.5%).Conclusions In recent years,the severe dengue comorbidity rates have significantly decreased in both adults and children,indicating that China's dengue prevention and control strategies have achieved remarkable results.The prominent clinical manifestations in adults are associated with organ damage,while children predominantly show gastrointestinal symptoms.Moving forward,efforts should be made to strengthen early diagnosis and standardized treatment to further reduce the clinical impact of dengue fever.