《登革热诊疗方案（2024年版）》解读

doi:10.19871/j.cnki.xfcrbzz.2024.06.015

摘要/Abstract

摘要： 随着全球气候变暖和人口流动增加,登革热的流行区域不断扩大,对公共卫生安全造成了威胁。《登革热诊疗方案（2024年版）》应运而生,旨在规范临床诊疗工作,提高登革热的诊断和治疗水平。本文解读《登革热诊疗方案（2024年版）》的主要内容,为临床医师提供诊疗指导,综合分析登革热的病原学特点、流行病学特征、发病机制、临床表现、实验室检查、诊断、重症登革热高危人群和早期预警指标、鉴别诊断、治疗原则、中医药辨证论治方案、预后及预防措施。诊疗方案强调了登革热的早期识别和治疗的重要性,提出了重症登革热的高危人群和早期预警指标,以及鉴别诊断要点。治疗方案涵盖了一般治疗、对症治疗和重症登革热的治疗,并特别强调了中医药辨证论治的重要性。《登革热诊疗方案（2024年版）》为临床医师提供了一套全面的诊疗指南,有助于提高登革热的诊断准确率和治疗效果,降低重症率和病死率。同时,该方案也强调了预防措施的重要性,提出了切断传播途径和个人防护的关键举措。

关键词: 登革热, 诊疗方案, 重症登革热, 中医药辨证论治, 解读

Abstract: With global climate change and increasing population mobility, the prevalence of dengue fever continues to expand, posing a threat to public health safety. The Dengue Diagnosis and Treatment Plan (2024 Edition) has emerged with the aim of standardizing clinical diagnosis and treatment work, and improving the diagnosis and treatment level of dengue fever. This article interprets the main content of the Dengue Fever Diagnosis and Treatment Plan (2024 Edition) and provides clinical doctors with diagnosis and treatment guidelines. Comprehensively analyze the pathogenic characteristics, epidemiological features, pathogenesis, clinical manifestations, laboratory tests, diagnosis, severe dengue fever, high-risk populations and early warning indicators, differential diagnosis, treatment principles, traditional Chinese medicine syndrome differentiation and treatment plans, prognosis and prevention measures of dengue fever. The 2024 diagnosis and treatment plan emphasizes the importance of early identification and treatment of dengue fever, proposes high-risk populations and early warning indicators for severe dengue fever, and highlights the key points of differential diagnosis. The treatment plan covers general treatment, symptomatic treatment, and treatment of severe dengue fever, with a special emphasis on the importance of traditional Chinese medicine's syndrome differentiation and treatment. The Dengue Diagnosis and Treatment Protocol (2024 Edition) provides a comprehensive set of diagnostic and treatment guidelines for clinical doctors, which helps to improve the diagnostic accuracy and treatment effectiveness of dengue fever, and reduce the severity and mortality rates. At the same time, the plan also emphasizes the importance of prevention measures, pointing out the criticality of cutting off transmission routes and strengthening personal protection.

Key words: Dengue fever, Diagnosis and treatment plan, Severe dengue fever, Traditional Chinese medicine syndrome differentiation and treatment, Interpretation

中图分类号:

R512.82

王成龙, 姜国臣, 刘晶哲. 《登革热诊疗方案（2024年版）》解读[J]. 新发传染病电子杂志, 2024, 9(6): 85-91.

Wang Chenglong, Jiang Guochen, Liu Jingzhe. Interpretation of Dengue fever diagnosis and treatment plan (2024 Edition)[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(6): 85-91.

参考文献

[1] WORLD HEALTH ORGANIZATION.Dengue and severe dengue[EB/OL].(2024-04-23)[2024-09-17]. https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue.
[2] 国家疾病预防控制局. 2023年全国法定传染病疫情概况[EB/OL]. (2024-9-18). https://www.ndcpa.gov.cn/jbkzzx/c100016/second/content/content_1836299733133275136.html.
[3] 高强,冷培恩. 登革热防控的现状与展望[J]. 中国热带医学,2024,24(1):40-48.
[4] GUZMAN MG,HARRIS E.Dengue[J]. Lancet,2015,385(9966):453-465.
[5] 牟笛,崔金朝,殷文武,等. 2015-2018年我国登革热暴发流行病学特征分析[J]. 中华流行病学杂志,2020,41(5):685-689.
[6] ECDC. Dengue worldwide overview[EB/OL]. (2024-09-02)[2024-09-17].https:// www.ecdc.europa.eu/en/dengue-monthly.
[7] 赵锦,周银柱,陈水连,等. 中国登革热发病趋势与时空分布特征[J]. 中国热带医学,2024,24(8):920-924.
[8] KHAN MB,YANG ZS,LIN CY,et al.Dengue overview: An updated systemic review[J]. J Infect Public Health,2023,16(10):1625-1642.
[9] JOHN DV,LIN YS,PERNG GC.Biomarkers of severe dengue disease - a review[J]. J Biomed Sci,2015,22:83.
[10] GUZMAN MG,KOURI G.Dengue and dengue hemorrhagic fever in the Americas: lessons and challenges[J]. J Clin Virol,2003,27(1):1-13.
[11] HASAN S,JAMDAR SF,ALALOWI M,et al.Dengue virus: A global human threat: Review of literature[J]. J Int Soc Prev Community Dent,2016,6(1):1-6.
[12] SARKER A,DHAMA N,GUPTA RD.Dengue virus neutralizing antibody: a review of targets, cross-reactivity, and antibody-dependent enhancement[J]. Front Immunol,2023,14:1200195.
[13] 杨小猛,江丽芳,赵丹,等. Ⅱ型登革病毒非结构蛋白1特异性T细胞系的构建和特征分析[J/CD]. 中华临床医师杂志(电子版),2012,6(16):4621-4625.
[14] PILLAI AB,MUTHURAMAN KR,MARIAPPAN V,et al.Oxidative stress response in the pathogenesis of dengue virus virulence, disease prognosis and therapeutics: an update[J]. Arch Virol,2019,164(12):2895-2908.
[15] BOS S,GADEA G,DESPRES P.Dengue: a growing threat requiring vaccine development for disease prevention[J]. Pathog Glob Health,2018,112(6):294-305.
[16] 张复春,何剑峰,彭劼,等. 中国登革热临床诊断和治疗指南[J]. 中华内科杂志,2018,57(9):642-648.
[17] KALAYANAROOJ S,VAUGHN DW,NIMMANNITYA S,et al.Early clinical and laboratory indicators of acute dengue illness[J]. J Infect Dis,1997,176(2):313-321.
[18] 马粤健,宋星宇,赵蜀崖. 登革热患者血小板减少原因的实验研究[J]. 中国热带医学,2008(11):1931-1932.
[19] 陈玉松,李吉良,余寿康. 登革热肾损害的临床分析[J]. 海南医学,1993(3):6-7.
[20] 洪文昕,张复春. 重症登革热临床特征、预警指征及危险因素的研究进展[J]. 传染病信息,2019,32(1):69-72.
[21] 程宛乔,许琪华,胡卫维,等. 754例成人登革热住院患者临床特征分析[J]. 热带医学杂志,2024,24(4):560-563.
[22] 余好,许少坚,孙华杰,等. 登革热急性发热期患者的部分实验室指标变化规律研究[J]. 中国医药科学,2016,6(7):163-165.
[23] 蔡银凤. 登革热患者凝血功能指标检测结果及其临床意义[J]. 实用医技杂志,2021,28(8):1006-1008.
[24] 中华人民共和国国家卫生和计划生育委员会.登革热诊疗指南(2014年第2版)[J]. 传染病信息,2014,27(5):262-265.
[25] 孙宁泽,郑晓燕. 登革热诊治研究进展[J]. 中国医刊,2024,59(1):22-25.
[26] 苟文曦,程镥轶,吴焜. 登革热诊疗的最新研究进展[J]. 中国病原生物学杂志,2024,19(10):1228-1233.
[27] PARKASH O,SHUEB RH.Diagnosis of Dengue Infection Using Conventional and Biosensor Based Techniques[J]. Viruses,2015,7(10):5410-5427.
[28] SIMMONS CP,FARRAR JJ,VV N,et al.Dengue[J]. N Engl J Med,2012,366(15):1423-1432.
[29] 林迪,孙长贵. 登革病毒感染及其实验室检查[J]. 实验与检验医学,2014,32(6):649-653.
[30] 赵令斋,庾蕾,洪文昕,等. 登革热患者IgM/IgG抗体动力学及相关因素分析[J/CD]. 新发传染病电子杂志,2018,3(2):102-105.
[31] 黄春旺,张舒眉. 登革热的腹部超声表现[J]. 胃肠病学和肝病学杂志,2008(6):469.
[32] 胡天丽,刘晋新. 登革热的临床影像学表现[J/CD]. 新发传染病电子杂志,2017,2(4):240-243.
[33] WORLD HEALTH ORGANIZATION.Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition[M]. Geneva: World Health Organization, 2009.
[34] 中华人民共和国国家卫生健康委员会. 登革热诊断(节选)[J]. 中华临床感染病杂志,2018,11(2):83-83.
[35] KUO HJ,LEE IK,LIU JW.Analyses of clinical and laboratory characteristics of dengue adults at their hospital presentations based on the World Health Organization clinical-phase framework: Emphasizing risk of severe dengue in the elderly[J]. J Microbiol Immunol Infect,2018,51(6):740-748.
[36] LIZARRAGA KJ,NAYER A.Dengue-associated kidney disease[J]. J Nephropathol,2014,3(2):57-62.
[37] 洪文昕,王建,邱爽,等. 121例成人重症登革热的临床特征及救治体会[J]. 中山大学学报(医学科学版),2016,37(3):333-336.
[38] OLIVEIRA JF,BURDMANN EA.Dengue-associated acute kidney injury[J]. Clin Kidney J,2015,8(6):681-685.
[39] CAROD-ARTAL FJ,WICHMANN O,FARRAR J,et al.Neurological complications of dengue virus infection[J]. Lancet Neurol,2013,12(9):906-919.
[40] PAZ-BAILEY G,ADAMS LE,DEEN J,et al.Dengue[J]. Lancet,2024,403(10427):667-682.
[41] 张复春. 登革热的诊断与治疗[M]:人民卫生出版社,2014.
[42] WORLD HEALTH ORGANIZATION. Handbook for clinical management of dengue[EB/OL]. (2012-11-13)https://www.who.int/publications/i/item/9789241504713.
[43] 林路平,范慧敏,李粤平,等. 重症登革热并血小板膜糖蛋白抗体阳性1例报道[J/CD]. 新发传染病电子杂志,2018,3(2):95-97.
[44] 史志云. 刘仕昌教授治疗登革热经验[J]. 新中医,1994(10):11-12.
[45] 李惠德. 登革热与登革出血热的中医辨治[J]. 新中医,1992(6):50-52.
[46] 张国雄,卢爱丽,刘译鸿,等. 登革热31例中医证候分析[J]. 中国中医急症,2008(7):943-944.
[47] 何世东. 中医辨证治疗登革热60例临床观察[J]. 广州中医药大学学报,1987(1):31-32.
[48] 徐家明. 登革热中医治疗的体会[J]. 广东医药学院学报,1994(3):199-200.
[49] 彭玉林,刘博仁. 辨证治疗登革热484例[J]. 新中医,1980(3):37-40.
[50] 王婷,刘城鑫,詹少锋,等. 登革热中医证治规律的数据挖掘[J]. 广州中医药大学学报,2024,41(9):2491-2499.
[51] 韩凡,莫锦,覃小兰,等. 从257例病例中探讨登革热的中医临床辨治[J]. 广州中医药大学学报,2014,31(6):855-859.
[52] 叶志中,刘南,余锋,等. 210例登革热患者中医证候分析[J]. 广州中医药大学学报,2015,32(1):15-18.
[53] 张沛,谭行华,张复春,等. 377例登革热中医症候特点分析[J]. 中华中医药杂志,2015,30(7):2532-2534.
[54] 刘领弟,刘娇,林路平,等. 345例登革热中医证候学特征及病因病机分析[J]. 中国中医急症,2016,25(7):1316-1318+1325.
[55] 郭世俊,蔡海荣,黄永莲,等. 2014年广州大学城登革热的临床特征分析[J]. 广州中医药大学学报,2015,32(5):796-798+807.
[56] 何姿函,黄志刚,李静姝,等. 中医药治疗登革热研究进展[J]. 现代中西医结合杂志,2023,32(14):2029-2033.
[57] CHEN YP,HO TS,LEE PC,et al.Effects of Chinese and Western Medicine on Patients with Dengue Fever[J]. Am J Chin Med,2020,48(2):329-340.
[58] 张复春. 中国登革热现状[J/CD]. 新发传染病电子杂志,2018,3(2):65-66,60.