84例成人登革热合并中枢神经系统损伤患者临床特征分析

doi:10.19871/j.cnki.xfcrbzz.2024.06.004

新发传染病电子杂志 ›› 2024, Vol. 9 ›› Issue (6): 20-25.doi: 10.19871/j.cnki.xfcrbzz.2024.06.004

84例成人登革热合并中枢神经系统损伤患者临床特征分析

杨慧勤¹, 林卓航², 金康虹², 廖璐², 冷星宇³, 王建¹, 洪文昕⁴, 王长泰⁵, 赵令斋⁶, 冯嘉敏², 李凌华¹, 李踔⁷, 张复春¹

1.广州医科大学附属市八医院感染病中心,广东广州 510440;
2.广州医科大学附属市八医院传染病研究所,广东广州 510440;
3.毕节市第三人民医院传染科,贵州毕节 551700;
4.广州市红十字会医院感染科,广东广州 510220;
5.安徽医科大学附属第二医院感染科,安徽合肥 230601;
6.广州医科大学附属市八医院检验科,广东广州 510440;
7.广州医科大学附属市八医院神经内科,广东广州 510440

收稿日期:2024-11-22 出版日期:2025-01-25 发布日期:2025-01-25
通讯作者: 张复春,Email: gz8hzfc@126.com
基金资助:
1.广州市科技计划项目（2023A03J0810,2024A03J01078）; 2.广州市中医药和中西医结合科技项目（20242A010014）

Clinical characteristics of 84 adult patients with dengue fever complicated with central nervous system injury

Yang Huiqin¹, Lin Zhuohang², Jin Kanghong², Liao Lu², Leng Xingyu³, Wang Jian¹, Hong Wenxin⁴, Wang Changtai⁵, Zhao Lingzhai⁶, Feng Jiamin², Li Linghua¹, Li Chuo⁷, Zhang Fuchun¹

1. Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangdong Guangzhou 510440, China;
2. Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangdong Guangzhou 510440, China;
3. Department of Infectious Diseases, The Third People's Hospital of Bijie, Guizhou Bijie 551700, China;
4. Department of Infectious Diseases, Guangzhou Red Cross Hospital, Guangdong Guangzhou 510220, China;
5. Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Anhui Hefei 230601, China;
6. Department of Clinical Laboratory, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangdong Guangzhou 510440, China;
7. Department of Neurology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangdong Guangzhou 510440, China

Received:2024-11-22 Online:2025-01-25 Published:2025-01-25

摘要/Abstract

摘要： 目的分析成人登革热合并中枢神经系统损伤患者的临床特征,为登革热合并中枢神经系统损伤的诊疗提供依据。方法利用广州医科大学附属市八医院登革热临床数据库,筛选2013年1月至2024年9月登革热合并中枢神经系统损伤的患者,按年龄是否<60岁分为非老年组和老年组,对比分析其一般资料、临床表现、实验室检查、脑脊液检查和细胞因子检测结果。结果纳入登革热合并中枢神经系统损伤的84例患者中,非老年患者27例（32.1%）,老年患者57例（67.9%）,中位年龄72.5岁,男性45例（53.6%）。中枢神经系统损伤表现形式主要有脑病（34例,40.5%）、腔隙性脑梗死（15例,17.9%）、脑梗死（11例,13.1%）、脑炎（11例,13.1%）。重症登革热72例（85.7%）,86.2%的患者为Ⅰ型登革病毒感染;合并基础疾病64例（76.2%）,以高血压（43例,51.2%）、糖尿病（24例,28.6%）和心脏病（20例,23.8%）为主;84例患者临床表现主要有头痛（36例,42.9%）、昏迷（36例,42.9%）、头晕（29例,34.5%）、嗜睡（23例,27.4%）、呕吐（18例,21.4%）、烦躁/抽搐（17例,20.2%）;33例（39.3%）合并其他器官损害,15例（17.9%）发生严重其他部位出血,54例（64.3%）出现渗漏征。患者血小板及白蛋白水平下降,细胞因子水平升高,脑脊液病原学检查阳性4例（4/18,22.2%）。治疗后,67例（79.8%）好转,17例（20.2%）未好转。具体到两组的比较中,老年合并基础疾病的比例,患高血压、心脏病的比例均显著高于非老年组（P<0.05）,老年组嗜睡的比例显著高于非老年组（35.1%比11.1%,P<0.05）,老年组与非老年组预后无显著性差异。结论登革热合并中枢神经系统损伤患者以老年人为主,合并高血压、糖尿病、心脏病比例高,以脑病为主,头痛、昏迷、嗜睡、头晕症状常见,出现意识水平改变时需要警惕中枢神经系统损伤发生的可能,早期进行脑脊液检查有助于明确诊断。

关键词: 登革热, 中枢神经系统损伤, 脑病, 成人, 临床特征

Abstract: Objective To analyze the clinical features of adult patients with dengue fever complicated with central nervous system(CNS) injury, and to provide evidence for the diagnosis and treatment of dengue fever complicated with CNS injury. Method The clinical database of dengue fever in our hospital was used to select adult patients with dengue fever complicated with CNS injury, and they were divided into non-elderly and elderly groups according to age <60 years. The general information, clinical manifestations, laboratory examination, cerebrospinal fluid examination, and cytokines detection results were compared and analyzed between the two groups. Result 84 cases of dengue fever complicated with CNS injury were included, 27 were non-elderly (32.1%), and 57 were elderly (67.9) %, with a median age of 72.5 years, 45 were male (53.6%), Of the 84 patients, the main forms of manifestations were encephalopathy (34 cases, 40.5%), lacunar infarction (15 cases, 17.9%), cerebral ischemia (11 cases, 13.1%), and encephalitis (11 cases, 13.1%). 72 cases (85.7%) were severe dengue, 86.2% of the patients were infected with dengue virus type 1. There were 64 cases (76.2%) of patients with underlying diseases, mainly hypertension (43 cases, 51.2%), diabetes (24 cases, 28.6%) and heart disease (20 cases, 23.8%). The clinical manifestations were mainly headache (36 cases, 42.9%), coma (36 cases, 42.9%), dizziness (29 cases, 34.5%), lethargy (23 cases, 27.4%), vomiting (18 cases, 21.4%), agitation/seizure (17 cases, 20.2%). 33 cases (39.3%) were found to have combined damage to other organs, 15 cases (17.9%) had serious bleeding in other parts of the body, and 54 cases (64.3%) showed signs of plasma leakage. The laboratory tests mainly showed a significant decrease in platelet and albumin levels, a significant increase in cytokine levels. Positive results for pathogenic examination of cerebrospinal fluid in 4 cases (22.2%). After treatment, 67 cases (79.8%) improved, while 17 cases (20.2%) deteriorated. The proportion of patients with underlying diseases, hypertension, and heart disease in the elderly group were significantly higher than that in the non-elderly group (P<0.05), and the proportion of patients with lethargy in the elderly group was significantly higher than that in the non-elderly group (35.1% vs 11.1%, P<0.05). There was no significant difference in prognosis between the two groups. Conclusion The majority of dengue fever patients with CNS injury are elderly, with a high proportion of combined with hypertension, diabetes and heart disease. Encephalopathy is the most common form. The manifestations are mainly headache, coma, lethargy, and dizziness, suggesting that it is necessary to be alert to the possibility of CNS injury when consciousness level changes, and early cerebrospinal fluid examination can help clarify the diagnosis.

Key words: Dengue fever, Central nervous system injury, Encephalopathy, Adult, Clinical features

中图分类号:

杨慧勤, 林卓航, 金康虹, 廖璐, 冷星宇, 王建, 洪文昕, 王长泰, 赵令斋, 冯嘉敏, 李凌华, 李踔, 张复春. 84例成人登革热合并中枢神经系统损伤患者临床特征分析[J]. 新发传染病电子杂志, 2024, 9(6): 20-25.

Yang Huiqin, Lin Zhuohang, Jin Kanghong, Liao Lu, Leng Xingyu, Wang Jian, Hong Wenxin, Wang Changtai, Zhao Lingzhai, Feng Jiamin, Li Linghua, Li Chuo, Zhang Fuchun. Clinical characteristics of 84 adult patients with dengue fever complicated with central nervous system injury[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(6): 20-25.

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84例成人登革热合并中枢神经系统损伤患者临床特征分析

Clinical characteristics of 84 adult patients with dengue fever complicated with central nervous system injury

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