Chang C S, Harn M R, Nimmannitya S
Department of Internal Medicine, Kaohsiung Medical College, Taiwan, Republic of China.
Gaoxiong Yi Xue Ke Xue Za Zhi. 1990 Mar;6(3):131-6.
Fifteen Thai children, diagnosed with dengue hemorrhagic fever and admitted to the Children's Hospital in Bangkok, were studied. All cases were serologically proved to be secondary dengue infections. The clinical signs and symptoms in the first few days of the acute febrile phase were similar to those observed in cases with classical dengue fever, and included continuously high fever, headache, muscle pain, nausea, vomiting and abdominal pain, etc. In the laboratory findings we noted hypoalbuminemia and mild elevation of the GOT and GPT. The hemogram showed an increasing atypical lymphocyte count during the acute febrile period. Prolongations of the partial thromboplastin time and thrombin time were also found, especially in the severe shock cases. All patients had varying degrees of hepatomegaly and pleural effusion from their chest x-rays accompanied by a rapid increase in the hematocrit of more than 20% and a fall in the platelet count to less than 100000/microliters. During the plasma leakage period the patients easily developed shock, even leading to death, unless adequate fluid supplies were given. This is also the major pathophysiological difference between dengue hemorrhagic fever and classical dengue fever. Although some studies concerning the pathogenesis of dengue hemorrhagic fever have been reported, but the exact mechanisms need further investigation.
对15名被诊断为登革出血热并入住曼谷儿童医院的泰国儿童进行了研究。所有病例经血清学证实为继发性登革热感染。急性发热期最初几天的临床体征和症状与典型登革热病例观察到的相似，包括持续高烧、头痛、肌肉疼痛、恶心、呕吐和腹痛等。在实验室检查结果中，我们注意到低白蛋白血症以及谷草转氨酶（GOT）和谷丙转氨酶（GPT）轻度升高。血常规显示急性发热期非典型淋巴细胞计数增加。还发现部分凝血活酶时间和凝血酶时间延长，尤其是在严重休克病例中。所有患者胸部X光检查均有不同程度的肝肿大和胸腔积液，同时血细胞比容迅速增加超过20%，血小板计数降至低于100000/微升。在血浆渗漏期，除非给予充足的液体供应，患者很容易发生休克，甚至导致死亡。这也是登革出血热与典型登革热之间主要的病理生理差异。虽然已经报道了一些关于登革出血热发病机制的研究，但确切机制仍需进一步研究。
