本文選題：登革熱　切入點：臨床特征　出處：《大理大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：【研究目的】研究2013和2015年西雙版納州登革病例的臨床特征,為我國醫(yī)療衛(wèi)生部門制定登革熱診療方案和控制登革熱流行提供依據(jù)�！狙芯糠椒ā繉�2013和2015年西雙版納州1009例登革熱住院病例進(jìn)行病例癥狀、體征和相關(guān)生化指標(biāo)回顧性分析,并采用SPSS統(tǒng)計軟件(17.0)進(jìn)行數(shù)據(jù)統(tǒng)計分析,率的比較采用c2檢驗。【結(jié)果】2013年西雙版納州登革熱(DF)暴發(fā)疫情主要以登革病毒血清型-3(DENV-3)為主,2015年DF的再次暴發(fā)則以DENV-2感染為主。經(jīng)對既往1009例DF病例研究發(fā)現(xiàn),該州人群對DENV普遍易感,其中以21-60歲青壯年比例最高(74.52%,752/1009)。在臨床癥狀方面,2013年和2015年的DENV感染病例臨床癥狀主要表現(xiàn)為中高度發(fā)熱、乏力、全身肌肉酸痛和食欲不振等,但DENV-3感染病例體溫普遍高于DENV-2感染,DENV-3感染病例納差、惡心發(fā)生率低于后者,但頭痛、骨痛、腹痛、腹瀉和出血發(fā)生率卻高于DENV-2感染,值得關(guān)注的是,DENV-2感染病例的出血表現(xiàn)更為復(fù)雜。在臨床體征方面,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壓痛多見,其中,DENV-2病例體征發(fā)生率高于DENV-3病例,且呈現(xiàn)多樣性;DENV-3感染出疹率高于DENV-2感染病例。分析證實2013年和2015年DF出現(xiàn)淋巴結(jié)腫大的病例并不多見,但DENV-3病例對血壓影響較大,更容易并發(fā)DSS。在相關(guān)生化指標(biāo)方面,2013年和2015年病例中血小板降低相同,但DENV-2病例對白細(xì)胞和HCT影響更顯著;DENV感染對腎臟影響較小,2013年DENV-3病例出現(xiàn)蛋白尿和血尿與2015年DENV-2病例相似。DENV感染容易影響凝血功能,DENV-2感染病例凝血功能異常發(fā)生率多于DENV-3感染,尤其是該型繼發(fā)纖溶亢進(jìn)幾率高,容易導(dǎo)致嚴(yán)重的出血和DIC。在肝功能檢測指標(biāo)方面,無論DENV-2病例還是DENV-3病例,它們的ALT、AST和GGT升高相同,損傷范圍多在于指標(biāo)正常上限2倍以內(nèi);DENV-2感染病例黃疸指數(shù)高于DENV-3感染;心肌酶譜檢測顯示DENV-2感染心肌損傷高于DENV-3病例,多數(shù)病例呈一過性心肌損傷;其它如C4、PCT、CRP、LDH和鐵蛋白等指標(biāo)的改變常有助于登革熱不同型別和其他感染發(fā)熱性疾病之間的鑒別。此外,腹部影像學(xué)檢測也發(fā)現(xiàn)登革病例的肝、脾腫大概率較小。同時,在伴發(fā)疾病分析中,基礎(chǔ)疾病和其它感染性疾病容易使DF轉(zhuǎn)化為重癥病例。【結(jié)論】2013年西雙版納州DENV-3病例癥狀和體征較典型,主要表現(xiàn)為中高度發(fā)熱、乏力、全身肌肉酸痛、食欲不振、皮疹和腹部壓痛等,2015年該州DENV-2病例癥狀和體征更加復(fù)雜,呼吸和循環(huán)系統(tǒng)癥狀及黃疸等發(fā)生幾率高,出現(xiàn)重癥病例傾向較高,主要表現(xiàn)在合并凝血功能紊亂、AST、ALT、黃疸指數(shù)和CK-MB升高較多見。研究結(jié)果提示,我國醫(yī)務(wù)工作者根據(jù)不同型別DF的癥狀、體征和實驗室生化指標(biāo)準(zhǔn)確判別登革病例,采取早期診斷和隔離治療,對于有效降低患者因重癥引起的死亡和防止DF疫情暴發(fā)具有重要價值,該研究應(yīng)引起醫(yī)療衛(wèi)生部門高度重視。
[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.
【學(xué)位授予單位】：大理大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.8

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