基于中医学因人制宜理论探讨登革热临床特征

发布时间：2018-10-08 14:13

【摘要】：目的：通过对2014年广东省中医院确诊为登革热患者的临床资料的回顾性调查分析,探讨登革热不同性别、年龄患者的临床特征,进一步了解登革热流行特点,完善相关流行病学资料,同时也探讨了不同中医证型登革热患者临床特点,从而加强对相应群体患者的相关监测,更好的指导临床预防、治疗工作的进行,改善登革热患者的总体预后。方法：根据研究目的及参考文献,制定病例信息采集表,利用医院电子病历系统对2014年6-10月广东省中医院总院及各分院门诊和住院确诊为登革热的患者的一般资料(包括姓名、性别、年龄、发病时间、既往病史等)、主要症状体征及实验室检查(白细胞、血小板、肝肾功能、心酶)等进行采集,使用Epidata3.0软件建立数据库,将数据导入SPSS19.0统计软件,根据数据类型及特点进行描述性分析、正态性检验、非参数检验、卡方检验、Fisher精确检验等。结果：共收集了1776例确诊为登革热患者的病历资料,其中男性861例,女性915例,年龄最小为1岁,最大为96岁,根据世界卫生组织年龄层次划分,将所有患者进行年龄分层,1-18岁年龄段(儿童组)有155例患者,百分比为8.7%,19-60岁年龄段(成人组)患者为915例,百分比为64.5%,61岁及以上(老年组)患者475例,百分比为26.7%。1.发热方面,1385例患者出现发热,体温最高者达42℃,平均体温为(38.90±0.69)℃,中、高度发热患者比例较高,分别占47.7%、37.6%；不同年龄组患者发热程度有差异,P=0.000,儿童组患者发热程度最高,老年组相对最低。高热组较低热组出血发生率存在统计学差异,P=0.032。发热程度与患者皮疹发生情况、白细胞和血小板下降程度、肝肾损害、心肌损害均无明显的相关性。2.皮疹方面,不同年龄组患者皮疹的发生率具有统计学差异,P=0.000,儿童组及成人组皮疹发生比例明显高于老年组,儿童组与成人组之间无差别。3.实验室检查方面,不同性别组患者在白细胞下降程度(P=0.000)、血小板下降程度(P=0.010)、肾功能损害(P=0.003)情况上差异具有统计学意义,女性组白细胞下降程度明显大于男性组,而男性组血小板下降程度明显大于女性组,男性登革热患者更易出现肾功能异常。不同年龄组患者在白细胞下降(P=0.002)、血小板下降(P=0.000)、肾功能损害(P=0.000)、心肌损害(P=0.004)方面具有统计学差异。成人组白细胞平均水平明显低于老年组；各个年龄组之间血小板下降程度均存在差异,但老年组血小板下降较儿童组与成人组均更严重；老年组患者肾功能损害情况较儿童组及成人组更多见；儿童组患者的心肌损害情况较成人组高发。血小板下降程度与出血情况存在显著的统计学差异,P=0.000,血小板越低出血风险越大。4.中医方面,剔除部分四诊资料不全病例,965例患者证属湿热型,602例患者证属暑燥型,两种证候类型患者在发热程度、发热持续时间、白细胞和血小板下降情况、转氨酶升高情况、心酶异常情况、皮疹和出血发生率上组间比较差异无统计学意义。湿热证组与暑燥证组患者出现肾功能异常差异具有统计学,P=0.020,湿热型患者更易出现肾功能损害。结论：人群对登革病毒普遍易感,年龄分布小至婴幼儿,大至高龄老人,感染登革热后患者以中、高度发热为主,少儿人群更易出现高热。高热患者出血风险更大。皮疹好发于中青年患者。在实验室检查方面,女性白细胞下降比男性明显,而男性的血小板下降较女性严重。成人组白细胞下降明显,老年组下降幅度相对较小,然而老年组患者血小板下降较儿童组及成人组明显。血小板的下降幅度与出血发生存在相关性。本次研究的患者肝脏损害的发病率为60.78%,转氨酶升高以AST为主,转氨酶的升高与年龄无明显相关性。男性患者及老年患者感染登革热后更易出现肾功能损害。儿童较成人及老人更易出现心肌损害。中医方面,仅见湿热证组患者肾损害较暑燥证组多发。
[Abstract]:Objective: To study the clinical characteristics of dengue fever patients with different sex and age through retrospective investigation and analysis of the clinical data of dengue patients in Guangdong Province in 2014, to further understand the epidemic characteristics of dengue fever and to improve relevant epidemiological data. At the same time, the clinical characteristics of different TCM syndrome type dengue fever patients are also discussed, so as to strengthen the relevant monitoring of patients with corresponding population, to guide the clinical prevention and treatment and improve the overall prognosis of patients with dengue fever. Methods: According to the purpose and reference of the study, a case information acquisition table was developed, and the general information (including name, sex, age and onset time) of patients with dengue fever was diagnosed by the hospital electronic medical record system from June to October 2014. Prior history, vital signs and laboratory tests (white blood cells, platelets, liver and kidney functions, cardiac enzymes), etc. were collected, the database was established using Epidata3. 0 software, data was imported into SPSS19. 0 statistical software, descriptive analysis was performed on the basis of data types and characteristics, and positive state inspection was performed. Non-inspection, card-side inspection, Fisher's exact inspection, etc. Results: A total of 1776 patients with dengue fever were collected, including 861 males and 915 females, with a minimum age of 1 and a maximum of 96 years, stratified by the WHO age hierarchy, age stratification of all patients, The percentage of patients aged 1-18 years (group of children) was 85.7%, 915 in the 19-60 age group (adult group), and in 475 patients with age 61 years and older (aged group), and the percentage was 26. 7%. In the case of fever, 1385 patients had fever, the highest body temperature was 42 鈩，

本文编号：2257063