云南省西双版纳州登革热临床特征研究

发布时间：2018-03-03 19:50

本文选题：登革热　切入点：临床特征　出处：《大理大学》2017年硕士论文　论文类型：学位论文

【摘要】：【研究目的】研究2013和2015年西双版纳州登革病例的临床特征,为我国医疗卫生部门制定登革热诊疗方案和控制登革热流行提供依据。【研究方法】对2013和2015年西双版纳州1009例登革热住院病例进行病例症状、体征和相关生化指标回顾性分析,并采用SPSS统计软件(17.0)进行数据统计分析,率的比较采用c2检验。【结果】2013年西双版纳州登革热(DF)暴发疫情主要以登革病毒血清型-3(DENV-3)为主,2015年DF的再次暴发则以DENV-2感染为主。经对既往1009例DF病例研究发现,该州人群对DENV普遍易感,其中以21-60岁青壮年比例最高(74.52%,752/1009)。在临床症状方面,2013年和2015年的DENV感染病例临床症状主要表现为中高度发热、乏力、全身肌肉酸痛和食欲不振等,但DENV-3感染病例体温普遍高于DENV-2感染,DENV-3感染病例纳差、恶心发生率低于后者,但头痛、骨痛、腹痛、腹泻和出血发生率却高于DENV-2感染,值得关注的是,DENV-2感染病例的出血表现更为复杂。在临床体征方面,2013年和2015年的DF病例主要以全身充血性多形性皮疹和腹部压痛多见,其中,DENV-2病例体征发生率高于DENV-3病例,且呈现多样性;DENV-3感染出疹率高于DENV-2感染病例。分析证实2013年和2015年DF出现淋巴结肿大的病例并不多见,但DENV-3病例对血压影响较大,更容易并发DSS。在相关生化指标方面,2013年和2015年病例中血小板降低相同,但DENV-2病例对白细胞和HCT影响更显著;DENV感染对肾脏影响较小,2013年DENV-3病例出现蛋白尿和血尿与2015年DENV-2病例相似。DENV感染容易影响凝血功能,DENV-2感染病例凝血功能异常发生率多于DENV-3感染,尤其是该型继发纤溶亢进几率高,容易导致严重的出血和DIC。在肝功能检测指标方面,无论DENV-2病例还是DENV-3病例,它们的ALT、AST和GGT升高相同,损伤范围多在于指标正常上限2倍以内;DENV-2感染病例黄疸指数高于DENV-3感染;心肌酶谱检测显示DENV-2感染心肌损伤高于DENV-3病例,多数病例呈一过性心肌损伤;其它如C4、PCT、CRP、LDH和铁蛋白等指标的改变常有助于登革热不同型别和其他感染发热性疾病之间的鉴别。此外,腹部影像学检测也发现登革病例的肝、脾肿大概率较小。同时,在伴发疾病分析中,基础疾病和其它感染性疾病容易使DF转化为重症病例。【结论】2013年西双版纳州DENV-3病例症状和体征较典型,主要表现为中高度发热、乏力、全身肌肉酸痛、食欲不振、皮疹和腹部压痛等,2015年该州DENV-2病例症状和体征更加复杂,呼吸和循环系统症状及黄疸等发生几率高,出现重症病例倾向较高,主要表现在合并凝血功能紊乱、AST、ALT、黄疸指数和CK-MB升高较多见。研究结果提示,我国医务工作者根据不同型别DF的症状、体征和实验室生化指标准确判别登革病例,采取早期诊断和隔离治疗,对于有效降低患者因重症引起的死亡和防止DF疫情暴发具有重要价值,该研究应引起医疗卫生部门高度重视。
[Abstract]:[objective] to study the clinical features of dengue cases in Xishuangbanna in 2013 and 2015. This study provides the basis for the establishment of dengue diagnosis and treatment program and the control of dengue fever epidemic in China's medical health departments. [methods] A retrospective analysis of the symptoms, signs and related biochemical indicators of 1009 cases of dengue fever in Xishuangbanna, Xishuangbanna in 2013 and 2015 was carried out. The statistical analysis is carried out by using SPSS statistical software (17. 0). [results] in 2013, dengue virus serotype -3 DENV-3 was the main outbreak of dengue fever in Xishuangbanna, and the second outbreak of DF in 2015 was mainly DENV-2 infection. The population of the state was generally susceptible to DENV, with the highest proportion of young adults aged 21-60 years (74.52 / 1009). In terms of clinical symptoms, the clinical symptoms of DENV infection cases in 2013 and 2015 were mainly of moderate fever, fatigue, systemic muscle soreness and loss of appetite, and so on. However, the body temperature of DENV-3 infection was higher than that of DENV-2 infection with DENV-3, and the incidence of nausea was lower than that of DENV-2 infection, but the incidence of headache, bone pain, abdominal pain, diarrhea and hemorrhage was higher than that of DENV-2 infection. It is important to note that the bleeding manifestations of DENV-2 infection cases are more complicated. In clinical signs, DF cases of 2013 and 2015 were mainly characterized by systemic congestive pleomorphic rash and abdominal tenderness. The incidence of physical signs of DENV-2 cases was higher than that of DENV-3 cases. The rash rate of DENV-3 infection was higher than that of DENV-2 infection. The incidence of lymphadenopathy in DF on 2013 and 2015 was rare, but the blood pressure was significantly affected by DENV-3 cases. More likely to be associated with DSS.Thrombocytopenia was the same in 2013 and 2015 cases. However, the effect of DENV infection on leukocytes and HCT was more significant in DENV-2 patients. In 2013, proteinuria and hematuria in DENV-3 patients were similar to those in 2015 DENV-2 patients. The incidences of abnormal coagulation function in DENV-3 patients with DENV-2 infection were higher than those in DENV-3 patients. In particular, the risk of secondary hyperfibrinolysis in this type is high, which can easily lead to severe hemorrhage and DIC.The alt and GGT levels in both DENV-2 cases and DENV-3 cases are the same as those in DENV-3 cases. The range of injury was that the jaundice index of patients with DENV-2 infection was higher than that of DENV-3 infection within 2 times of normal upper limit, the myocardial damage of DENV-2 infected patients was higher than that of DENV-3 cases, and most of the cases showed transient myocardial injury. Changes in other markers such as LDH and ferritin in the C4PCTX CRPU often contribute to the differential diagnosis between different types of dengue fever and other infectious febrile diseases. In addition, abdominal imaging tests also showed that the liver and spleen were less likely to be enlarged in patients with dengue. At the same time, In the analysis of accompanying diseases, basic diseases and other infectious diseases can easily turn DF into severe cases. [conclusion] in 2013, the symptoms and signs of DENV-3 cases in Xishuangbanna were typical, mainly manifested by moderate fever, fatigue, and muscle soreness of the whole body. In 2015, symptoms and signs of DENV-2 cases in the state were more complicated, respiratory and circulatory system symptoms and jaundice were higher, and severe cases tended to occur more frequently. The main manifestations were the increase of AST alt, jaundice index and CK-MB. The results suggested that Chinese medical workers could accurately distinguish the dengue cases according to the symptoms, signs and laboratory biochemical indexes of different types of DF. Early diagnosis and isolation therapy are of great value in reducing the death caused by severe illness and preventing the outbreak of DF. This study should be paid more attention to by the medical and health departments.
【学位授予单位】：大理大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.8

【参考文献】