Kalayanarooj Siripen, Nimmannitya Suchitra
Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand.
Southeast Asian J Trop Med Public Health. 2005 Mar;36(2):378-84.
A retrospective review of dengue patients admitted to Queen Sirikit National Institute of Child Health (previously known as Children's Hospital) from 1995 to 1999 revealed 4,532 confirmed cases of dengue infection; 80.9% were dengue hemorrhagic fever (DHF) and 19.1% were dengue fever cases (DF). Among the DHF patients; 30.6% had shock. The majority of them, 66.6%, had a normal nutritional status, while 9.3% were malnourished and 24.2% had obesity as classified by weight for age. Compared with control patients with other diagnoses (excluding HIV/AIDS patients), malnourished children had a lower risk of contracting dengue infection (odds ratio = 0.48, 95% Cl = 0.39-0.60, p = 0.000) while obese children had a greater risk of infection with dengue viruses (odds ratio = 1.96, 95% Cl = 1.55-2.5, p = 0.000). The clinical signs, symptoms and laboratory findings of dengue were almost the same among the 3 groups of malnourished, normal, and obese patients. The minor differences observed were that in obese children liver enlargement was found less often; maculopapular/convalescence rash and elevations of alanine aminotransferase were found more often. Malnourished patients had a higher risk of developing shock (37.8%) than normal (29.9%) and obese patients (30.2%) (p = 0.000). Obese patients had more unusual presentations: encephalopathy (1.3%) and associated infections (4.8%), than normal (0.5% and 2.7%) and malnourished patients (1.2% and 3.1%). Complications of fluid overload were found more in obese patients (6.5%) compared to normal (3.2%) and malnourished patients (2.1%) (p = 0.000). The case-fatality rates (CFR) in malnourished patients and obese patients were 0.5% and 0.4%, respectively, while in normal patients the CFR was 0.07%. Under and over nutrition DHF patients had either a greater risk of shock or unusual presentations and complications, which can lead to severe disease or complications and probably a higher CFR.
对1995年至1999年期间入住诗丽吉王后国家儿童健康研究所（前身为儿童医院）的登革热患者进行的回顾性研究显示，确诊登革热感染病例有4532例；其中80.9%为登革出血热（DHF），19.1%为登革热（DF）病例。在DHF患者中，30.6%出现休克。其中大多数（66.6%）营养状况正常，而根据年龄体重分类，9.3%为营养不良，24.2%为肥胖。与其他诊断的对照患者（不包括艾滋病毒/艾滋病患者）相比，营养不良儿童感染登革热的风险较低（优势比=0.48，95%置信区间=0.39 - 0.60，p = 0.000），而肥胖儿童感染登革病毒的风险更高（优势比=1.96，95%置信区间=1.55 - 2.5，p = 0.000）。营养不良、正常和肥胖三组患者的登革热临床体征、症状和实验室检查结果几乎相同。观察到的细微差异是，肥胖儿童肝肿大较少见；斑丘疹/恢复期皮疹和丙氨酸转氨酶升高较多见。营养不良患者发生休克的风险（37.8%）高于正常患者（29.9%）和肥胖患者（30.2%）（p = 0.000）。肥胖患者有更多不寻常表现：脑病（1.3%）和相关感染（4.8%），高于正常患者（0.5%和2.7%）和营养不良患者（1.2%和3.1%）。与正常患者（3.2%）和营养不良患者（2.1%）相比，肥胖患者液体超负荷并发症更多见（6.5%）（p = 0.000）。营养不良患者和肥胖患者的病死率分别为0.5%和0.4%，而正常患者的病死率为0.07%。营养不足和营养过剩的DHF患者发生休克、不寻常表现和并发症的风险更高，这可能导致严重疾病或并发症，可能病死率也更高。
