Toledo Joao, George Leyanna, Martinez Eric, Lazaro Adhara, Han Wai Wai, Coelho Giovanini E, Runge Ranzinger Silvia, Horstick Olaf
Consultant in Public Health, Ministry of Health, Brasilia, Brazil.
Department of Community Medicine, Amrita School of Medicine, Amrita Vishwa Vidyapeetham University, Kochi, India.
PLoS Negl Trop Dis. 2016 Jan 4;10(1):e0004284. doi: 10.1371/journal.pntd.0004284. eCollection 2016 Jan.
Patients with dengue fever and comorbidities seem to be at higher risk of developing complications and/or severe dengue compared to healthier individuals. This study systematically reviews the evidence related to comorbidities and dengue. A systematic literature review was performed in five databases (EMBASE, PUBMED, Global Health, SciELO, Cochrane) and grey literature for full-text articles since its inceptions until October 10, 2015. A total of 230 articles were retrieved. Sixteen studies were analysed after applying all inclusion and exclusion criteria. Seven case control studies and nine retrospective cohort studies showed that comorbidities may contribute to severe dengue, especially 1) cardiovascular disease, 2) stroke, 3) diabetes, 4) respiratory disease and 5) renal disease, as well as old age. However, due to heterogeneity in studies, the real estimate effect of comorbidities as modifiers of dengue severity could not be established. Further research in regions with high prevalence of dengue infection would contribute to a better understanding of the relevance of comorbidities in severe dengue, especially with a standardised protocol, for outcomes, specific comorbidities, study design-best using prospective designs-and sample sizes.
与健康个体相比，登革热患者及其合并症患者似乎更易出现并发症和/或重症登革热。本研究系统回顾了与合并症和登革热相关的证据。对五个数据库（EMBASE、PUBMED、Global Health、SciELO、Cochrane）及灰色文献进行了系统的文献回顾，以检索自数据库建立至2015年10月10日的全文文章。共检索到230篇文章。在应用所有纳入和排除标准后，对16项研究进行了分析。7项病例对照研究和9项回顾性队列研究表明，合并症可能导致重症登革热，尤其是1）心血管疾病、2）中风、3）糖尿病、4）呼吸系统疾病和5）肾脏疾病，以及高龄。然而，由于研究存在异质性，无法确定合并症作为登革热严重程度调节因素的实际估计效应。在登革热感染高发地区开展进一步研究，将有助于更好地理解合并症在重症登革热中的相关性，特别是采用标准化方案，针对结局、特定合并症、研究设计（最好采用前瞻性设计）和样本量进行研究。
