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登革热患者口服钙加维生素D的临床反应:5例研究

Clinical response in patients with dengue fever to oral calcium plus vitamin D administration: study of 5 cases.

作者信息

Sánchez-Valdéz Emilio, Delgado-Aradillas Melissa, Torres-Martínez José Angel, Torres-Benítez José Martín

机构信息

Community Center "Las Américas" Tampico, Tamaulipas, México.

出版信息

Proc West Pharmacol Soc. 2009;52:14-7.

Abstract

A dengue epidemic is one of the most important public health problems in the tropical and subtropical areas of the World. In 2005, 7,062 dengue cases were reported in Tamaulipas on Mexico's eastern coast, including 1,832 (26%) cases classified as Dengue Hemorrhagic Fever (DHF). Dengue fever (DF) is characterized by fever, intense headache, myalgias, arthralgias, rash, nausea and vomiting. A proportion of infected persons may develop DHF characterized by prominent hemorrhagic manifestations associated with thrombocytopenia. An immune mechanism of thrombocytopenia due to increased platelet destruction appears to be operative in patients with DHF. Excessive capillary permeability may lead to Dengue Shock Syndrome (DSS). Patients with DHF/DSS who also have prolonged fever (> 5 days) are at high risk for concurrent bacteremia. Standard treatment is limited to electrolytic solutions, rest, measurements of body temperature, blood pressure, hematocrit, platelet count, and administration of antipyretics like paracetamol when fever is too high. Extracellular calcium plays a key role in platelet aggregation and for the regulation of the immune response in personsinfected with Dengue Virus (DV), and dihydroxy-vitamin D has recently been found to alter IL-12 expression anddendritic cell maturation. We report the cases of five patients who received oral calcium carbonate plus Vitamin D3, who improved overall clinical condition and reduced the duration of signs and symptoms of DF.

摘要

登革热疫情是世界热带和亚热带地区最重要的公共卫生问题之一。2005年,墨西哥东海岸的塔毛利帕斯州报告了7062例登革热病例,其中1832例(26%)被归类为登革出血热(DHF)。登革热(DF)的特征为发热、剧烈头痛、肌痛、关节痛、皮疹、恶心和呕吐。一部分感染者可能会发展为登革出血热,其特征为与血小板减少相关的明显出血表现。血小板破坏增加导致的血小板减少免疫机制似乎在登革出血热患者中起作用。毛细血管通透性过高可能导致登革休克综合征(DSS)。登革出血热/登革休克综合征且发热持续时间延长(>5天)的患者发生并发菌血症的风险很高。标准治疗仅限于电解质溶液、休息、测量体温、血压、血细胞比容、血小板计数,以及在发热过高时给予对乙酰氨基酚等退烧药。细胞外钙在血小板聚集中起关键作用,并且在感染登革病毒(DV)的人群中对免疫反应的调节起关键作用,最近发现二羟基维生素D可改变白细胞介素-12的表达和树突状细胞的成熟。我们报告了5例接受口服碳酸钙加维生素D3治疗的患者的病例,这些患者的整体临床状况得到改善,登革热体征和症状的持续时间缩短。

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