Phuong Cao Xuan Thanh, Nhan Ngo Thi, Kneen Rachel, Thuy Pham Thi Thu, van Thien Chu, Nga Nguyen Thi Thuy, Thuy Tran Thanh, Solomon Tom, Stepniewska Kasia, Wills Bridget
Dong Nai Paediatric Centre, Dong Nai Province, Bien Hoa, Vietnam.
Am J Trop Med Hyg. 2004 Feb;70(2):172-9.
Classification of dengue using the current World Health Organization (WHO) system is not straightforward. In a large prospective study of pediatric dengue, no clinical or basic laboratory parameters clearly differentiated between children with and without dengue, although petechiae and hepatomegaly were independently associated with the diagnosis. Among the 712 dengue-infected children there was considerable overlap in the major clinical features. Mucosal bleeding was observed with equal frequency in those with dengue fever and dengue hemorrhagic fever (DHF), and petechiae, thrombocytopenia, and the tourniquet test differentiated poorly between the two diagnostic categories. Fifty-seven (18%) of 310 with shock did not fulfill all four criteria considered necessary for a diagnosis of DHF by the WHO, but use of the WHO provisional classification scheme resulted in considerable over-inflation of the DHF figures. If two separate entities truly exist rather than a continuous spectrum of disease, it is essential that some measure of capillary leak is included in any classification system, with less emphasis on bleeding and a specific platelet count.
使用世界卫生组织（WHO）现行系统对登革热进行分类并非易事。在一项针对儿童登革热的大型前瞻性研究中，尽管瘀点和肝肿大与诊断独立相关，但没有临床或基础实验室参数能够明确区分患有和未患有登革热的儿童。在712名感染登革热的儿童中，主要临床特征存在相当大的重叠。登革热发热和登革出血热（DHF）患者出现黏膜出血的频率相同，瘀点、血小板减少和束臂试验在这两种诊断类别之间的区分效果不佳。310名休克患者中有57名（18%）不符合WHO认为诊断DHF所需的全部四项标准，但使用WHO临时分类方案导致DHF数据大幅虚增。如果真的存在两个独立的实体而非疾病的连续谱，那么在任何分类系统中纳入某种毛细血管渗漏的衡量指标至关重要，同时减少对出血和特定血小板计数的强调。
