摘要
【目的】分析肺部受累与重症登革热(SD)的关系,以提高对SD的早期识别。【方法】回顾分析2014年7月至2018年10月中山大学附属第三医院收治的227例登革热病例资料,分析其临床特点、实验室与影像学资料、治疗及预后,探索肺部受累与SD的关系。【结果】老年、吸烟、高血压、糖尿病、脑血管病者在登革热肺部受累组明显高于肺部未受累组(χ^2=25.146、3.847、10.326、7.177和5.355,P=0.000、0.050、0.001、0.007和0.021)。咳嗽、气促发生率在肺部受累组明显增高(χ^2=11.465、6.068;P=0.001、0.014),在SD亚组也明显高于普通登革热亚组(χ^2=4.585、6.717;P=0.032、0.010)。肺部受累组C反应蛋白及降钙素原增高(Z=-2.591、-3.033;P=0.010、0.002)。胸腔积液在SD亚组发生率高(χ^2=4.987,P=0.026),双肺炎性渗出与SD有相关性(χ^2=5.910,P=0.015)。肺部受累组易并发急性肝、肾功能损害及多器官功能障碍综合征(MODS)(χ^2=7.044、7.059、11.315,P=0.008、0.008、0.001)。肺部受累组抗病毒、抗细菌及两者联合用药的比例均明显高于肺部未受累组(χ^2分别为13.156、32.845与12.684,P均<0.001)。【结论】老年、吸烟、高血压、糖尿病、脑血管病登革热患者易并发肺部受累,咳嗽、气促、胸腔积液及双肺炎性渗出等肺部受累情况在SD中比例增高,应关注这些表现的登革热病例进展至SD的风险。
【Objective】To investigate the differences of lung involvement between dengue and severe dengue.【Methods】 227 dengue patients admitted in The Third Affiliated Hospital of Sun Yat-sen University from July 2014 to October 2018 were enrolled. The clinical characteristics,treatment and outcome of the patients were analyzed to explore the differences of lung involvement between dengue and severe dengue(SD).【Results】The rate of old age,smoking,hypertension,diabetes and cerebrovascular disease was higher in dengue with lung involvement group(DWLI)than dengue without lung involvement group(DWOLI)(χ^2 were 25.146,3.847,10.326 ,7.177,and 5.355,P was 0.050 for smoking,the others were < 0.05). The rate of cough and breathlessness was higher in DWLI(χ^2 were 11.465 and 6.068,P were 0.001 and 0.014),as well as in SD subgroup(χ^2 were 4.585 and 6.717,P were 0.032 and 0.010). C-reactive protein and procalcitonin were increased in DWLI(Z were -2.591 and -3.033,P were 0.010 and 0.002). The rate of pleural effusion was higher in SD subgroup(χ^2 = 4.987,P = 0.026). Bilateral lung infiltration was correlated with SD(χ^2 = 5.910,P = 0.015). The rate of acute liver injury,acute kidney injury and multi-organ dysfunction syndrome(MODS)was higher in DWLI(χ^2 were 7.044,7.059,and 11.315,P were 0.008,0.008 and 0.001). The rate of anti-virus,anti-bacteria and combined therapy was higher in DWLI(χ^2 were 13.156,32.845, and 12.684,P all were < 0.001).【Conclusion】Dengue patients who were with old age,smoking,or suffered from underlying disease of hypertension,diabetes and cerebro-vascular disease were vulnerable to lung involvement. Cough, breathlessness,pleural effusion and bilateral lung infiltration were signs of severe dengue. Attention should be paid to dengue with lung involvement.
作者
石云锋
师小函
周来知
巴俊慧
淦伟强
童裕维
吴本权
SHI Yun-feng;SHI Xiao-han;ZHOU Lai-zhi;BA Jun-hui;GANWei-qiang;Tong Yu-wei;WU Ben-quan(Department of MICU//Department of Pulmonary and Critical Care Medicine,The Third Affiliated Hospital of Sun Yatsen University,Guangzhou 510630,China;Department of Infectious Diseases,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Cardiology,Guangzhou Eighth People’s Hospital,Guangzhou 510060,China)
出处
《中山大学学报（医学版）》
CAS
CSCD
北大核心
2019年第5期774-780,共7页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省医学科研基金(A2015610)
