Htun Nan Shwe Nwe, Odermatt Peter, Eze Ikenna C, Boillat-Blanco Noémie, D'Acremont Valérie, Probst-Hensch Nicole
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
PLoS Negl Trop Dis. 2015 Apr 24;9(4):e0003741. doi: 10.1371/journal.pntd.0003741. eCollection 2015 Apr.
The mean age of acute dengue has undergone a shift towards older ages. This fact points towards the relevance of assessing the influence of age-related comorbidities, such as diabetes, on the clinical presentation of dengue episodes. Identification of factors associated with a severe presentation is of high relevance, because timely treatment is the most important intervention to avert complications and death. This review summarizes and evaluates the published evidence on the association between diabetes and the risk of a severe clinical presentation of dengue.
METHODOLOGY/FINDINGS: A systematic literature review was conducted using the MEDLINE database to access any relevant association between dengue and diabetes. Five case-control studies (4 hospital-based, 1 population-based) compared the prevalence of diabetes (self-reported or abstracted from medical records) of persons with dengue (acute or past; controls) and patients with severe clinical manifestations. All except one study were conducted before 2009 and all studies collected information towards WHO 1997 classification system. The reported odds ratios were formally summarized by random-effects meta-analyses. A diagnosis of diabetes was associated with an increased risk for a severe clinical presentation of dengue (OR 1.75; 95% CI: 1.08-2.84, p = 0.022).
CONCLUSIONS/SIGNIFICANCE: Large prospective studies that systematically and objectively obtain relevant signs and symptoms of dengue fever episodes as well as of hyperglycemia in the past, and at the time of dengue diagnosis, are needed to properly address the effect of diabetes on the clinical presentation of an acute dengue fever episode. The currently available epidemiological evidence is very limited and only suggestive. The increasing global prevalence of both dengue and diabetes justifies further studies. At this point, confirmation of dengue infection as early as possible in diabetes patients with fever if living in dengue endemic regions seems justified. The presence of this co-morbidity may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue.
急性登革热的平均发病年龄已出现向高龄转变的趋势。这一事实表明评估年龄相关合并症（如糖尿病）对登革热发作临床表现的影响具有重要意义。识别与严重临床表现相关的因素至关重要，因为及时治疗是避免并发症和死亡的最重要干预措施。本综述总结并评估了已发表的关于糖尿病与登革热严重临床表现风险之间关联的证据。
方法/结果：使用MEDLINE数据库进行系统的文献综述，以获取登革热与糖尿病之间的任何相关关联。五项病例对照研究（4项基于医院，1项基于人群）比较了登革热患者（急性或既往感染；对照组）和有严重临床表现患者的糖尿病患病率（自我报告或从病历中提取）。除一项研究外，所有研究均在2009年之前进行，且所有研究均按照世界卫生组织1997年分类系统收集信息。通过随机效应荟萃分析对报告的比值比进行了正式总结。糖尿病诊断与登革热严重临床表现风险增加相关（比值比1.75；95%置信区间：1.08 - 2.84，p = 0.022）。
结论/意义：需要开展大型前瞻性研究，系统且客观地获取登革热发作以及过去和登革热诊断时高血糖的相关体征和症状，以恰当探讨糖尿病对急性登革热发作临床表现的影响。目前可得的流行病学证据非常有限且仅具有提示性。登革热和糖尿病在全球的患病率不断上升，这证明有必要进一步开展研究。此时，对于生活在登革热流行地区且发热的糖尿病患者，尽早确诊登革热感染似乎是合理的。这种合并症的存在可能需要更密切地观察血糖控制情况，并调整液体管理，以降低登革热严重临床表现的风险。
