Shashidhara K C, Murthy K A Sudharshan, Gowdappa H Basavana, Bhograj Abhijith
Associate Professor, Department of Medicine, J.S.S Medical College , Ramanuja Road, Mysore - 570004, Karnataka, India .
J Clin Diagn Res. 2013 Jul;7(7):1397-400. doi: 10.7860/JCDR/2013/6135.3143. Epub 2013 Jul 1.
Dengue infection is the most rapidly spreading mosquito-borne viral disease in the world and an estimated 50 million dengue infections reported annually. The pathogenesis of Thrombocytopenia in dengue fever (DF) is not clearly understood. Increased peripheral destruction of antibody coated platelets and acute bone marrow suppression were strongly suspected as the possible mechanism. This often leads to life threatening dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS). Steroids are used in the treatment of Idiopathic thrombocytopenic purpura to increase the platelet count which is mediated by auto antibodies .This hypothesis would support the use of steroids in dengue fever.
The objective of this study was to test whether an intravenous high dose dexamethasone was efficacious in increasing the platelet count in acute stage of dengue fever with thrombocytopenia.
During the study period between June 2010 - 2011 in JSS Hospital Mysore, 127 patients were screened for dengue fever with thrombocytopenia (<50000/cumm) and 61patients were randomly allocated, 30 to the study group and 31 to the control group, in an open labeled study. The study group received intravenous dexamethasone 8mg initially followed by 4 mg every 8 h thereafter for 4 days and IV fluids whenever required. The control Group received only IV fluids and antipyretics whenever it was indicated. The daily measurement of platelet count was carried out in all patients from the day of enrolment to the fourth day of post treatment.
The baseline data (age, sex, and the mean duration of the illness, Hb%, haematocrit, and platelets) were similar in both the groups. The analysis of variance (ANOVA) statistics showed a significant linear association of the mean platelet counts with the days in either group. The mean platelet counts increased steadily in both the groups from days 1 to 4: day1 (0.687), day2 (0.34), day3 (0.530) and day4 (0.844). There was no significant difference between the two groups.
We conclude that at a high dose dexamethasone regimen was not effective in achieving a higher rise in the platelet count in the acute stage of dengue fever.
登革热感染是世界上传播速度最快的蚊媒病毒性疾病，每年估计有5000万例登革热感染病例。登革热（DF）中血小板减少的发病机制尚不清楚。抗体包被血小板的外周破坏增加和急性骨髓抑制被强烈怀疑为可能的机制。这常常导致危及生命的登革出血热（DHF）和登革休克综合征（DSS）。类固醇用于治疗特发性血小板减少性紫癜以增加由自身抗体介导的血小板计数。这一假说支持在登革热中使用类固醇。
本研究的目的是测试静脉注射高剂量地塞米松是否能有效增加登革热急性期血小板减少患者的血小板计数。
在2010年6月至2011年期间于迈索尔JSS医院进行的研究中，对127例血小板减少（<50000/立方毫米）的登革热患者进行了筛查，并在一项开放标签研究中将61例患者随机分配，30例至研究组，31例至对照组。研究组最初静脉注射地塞米松8毫克，此后每8小时注射4毫克，共4天，并根据需要补充静脉输液。对照组仅在需要时接受静脉输液和解热药。从入组当天到治疗后第四天，对所有患者进行每日血小板计数测量。
两组的基线数据（年龄、性别、平均病程、血红蛋白百分比、血细胞比容和血小板）相似。方差分析（ANOVA）统计显示，两组中平均血小板计数与天数之间存在显著的线性关联。两组的平均血小板计数从第1天到第4天稳步增加：第1天（0.687）、第2天（0.34）、第3天（0.530）和第4天（0.844）。两组之间没有显著差异。
我们得出结论，高剂量地塞米松方案在登革热急性期未能有效使血小板计数有更高的升高。
