【摘要】：目的：通過對2014年廣東省中醫(yī)院確診為登革熱患者的臨床資料的回顧性調(diào)查分析,探討登革熱不同性別、年齡患者的臨床特征,進(jìn)一步了解登革熱流行特點,完善相關(guān)流行病學(xué)資料,同時也探討了不同中醫(yī)證型登革熱患者臨床特點,從而加強(qiáng)對相應(yīng)群體患者的相關(guān)監(jiān)測,更好的指導(dǎo)臨床預(yù)防、治療工作的進(jìn)行,改善登革熱患者的總體預(yù)后。方法：根據(jù)研究目的及參考文獻(xiàn),制定病例信息采集表,利用醫(yī)院電子病歷系統(tǒng)對2014年6-10月廣東省中醫(yī)院總院及各分院門診和住院確診為登革熱的患者的一般資料(包括姓名、性別、年齡、發(fā)病時間、既往病史等)、主要癥狀體征及實驗室檢查(白細(xì)胞、血小板、肝腎功能、心酶)等進(jìn)行采集,使用Epidata3.0軟件建立數(shù)據(jù)庫,將數(shù)據(jù)導(dǎo)入SPSS19.0統(tǒng)計軟件,根據(jù)數(shù)據(jù)類型及特點進(jìn)行描述性分析、正態(tài)性檢驗、非參數(shù)檢驗、卡方檢驗、Fisher精確檢驗等。結(jié)果：共收集了1776例確診為登革熱患者的病歷資料,其中男性861例,女性915例,年齡最小為1歲,最大為96歲,根據(jù)世界衛(wèi)生組織年齡層次劃分,將所有患者進(jìn)行年齡分層,1-18歲年齡段(兒童組)有155例患者,百分比為8.7%,19-60歲年齡段(成人組)患者為915例,百分比為64.5%,61歲及以上(老年組)患者475例,百分比為26.7%。1.發(fā)熱方面,1385例患者出現(xiàn)發(fā)熱,體溫最高者達(dá)42℃,平均體溫為(38.90±0.69)℃,中、高度發(fā)熱患者比例較高,分別占47.7%、37.6%；不同年齡組患者發(fā)熱程度有差異,P=0.000,兒童組患者發(fā)熱程度最高,老年組相對最低。高熱組較低熱組出血發(fā)生率存在統(tǒng)計學(xué)差異,P=0.032。發(fā)熱程度與患者皮疹發(fā)生情況、白細(xì)胞和血小板下降程度、肝腎損害、心肌損害均無明顯的相關(guān)性。2.皮疹方面,不同年齡組患者皮疹的發(fā)生率具有統(tǒng)計學(xué)差異,P=0.000,兒童組及成人組皮疹發(fā)生比例明顯高于老年組,兒童組與成人組之間無差別。3.實驗室檢查方面,不同性別組患者在白細(xì)胞下降程度(P=0.000)、血小板下降程度(P=0.010)、腎功能損害(P=0.003)情況上差異具有統(tǒng)計學(xué)意義,女性組白細(xì)胞下降程度明顯大于男性組,而男性組血小板下降程度明顯大于女性組,男性登革熱患者更易出現(xiàn)腎功能異常。不同年齡組患者在白細(xì)胞下降(P=0.002)、血小板下降(P=0.000)、腎功能損害(P=0.000)、心肌損害(P=0.004)方面具有統(tǒng)計學(xué)差異。成人組白細(xì)胞平均水平明顯低于老年組；各個年齡組之間血小板下降程度均存在差異,但老年組血小板下降較兒童組與成人組均更嚴(yán)重；老年組患者腎功能損害情況較兒童組及成人組更多見；兒童組患者的心肌損害情況較成人組高發(fā)。血小板下降程度與出血情況存在顯著的統(tǒng)計學(xué)差異,P=0.000,血小板越低出血風(fēng)險越大。4.中醫(yī)方面,剔除部分四診資料不全病例,965例患者證屬濕熱型,602例患者證屬暑燥型,兩種證候類型患者在發(fā)熱程度、發(fā)熱持續(xù)時間、白細(xì)胞和血小板下降情況、轉(zhuǎn)氨酶升高情況、心酶異常情況、皮疹和出血發(fā)生率上組間比較差異無統(tǒng)計學(xué)意義。濕熱證組與暑燥證組患者出現(xiàn)腎功能異常差異具有統(tǒng)計學(xué),P=0.020,濕熱型患者更易出現(xiàn)腎功能損害。結(jié)論：人群對登革病毒普遍易感,年齡分布小至嬰幼兒,大至高齡老人,感染登革熱后患者以中、高度發(fā)熱為主,少兒人群更易出現(xiàn)高熱。高熱患者出血風(fēng)險更大。皮疹好發(fā)于中青年患者。在實驗室檢查方面,女性白細(xì)胞下降比男性明顯,而男性的血小板下降較女性嚴(yán)重。成人組白細(xì)胞下降明顯,老年組下降幅度相對較小,然而老年組患者血小板下降較兒童組及成人組明顯。血小板的下降幅度與出血發(fā)生存在相關(guān)性。本次研究的患者肝臟損害的發(fā)病率為60.78%,轉(zhuǎn)氨酶升高以AST為主,轉(zhuǎn)氨酶的升高與年齡無明顯相關(guān)性。男性患者及老年患者感染登革熱后更易出現(xiàn)腎功能損害。兒童較成人及老人更易出現(xiàn)心肌損害。中醫(yī)方面,僅見濕熱證組患者腎損害較暑燥證組多發(fā)。
[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，

本文編號：2257063