Iqtadar Somia, Akbar Nabeel, Huma Naima, Randhawa Fawad Ahmad
Dr. Somia Iqtadar, FCPS (Medicine). Associate Professor of Medicine. King Edward Medical University, Lahore, Pakistan.
Dr. Nabeel Akbar, MBBS. Postgraduate Resident of Cardiology. Punjab Institute of Cardiology, Lahore, Pakistan.
Pak J Med Sci. 2017 Jul-Aug;33(4):963-967. doi: 10.12669/pjms.334.13026.
To estimate the range of hepatic involvement in dengue infections by assessing clinical and biochemical profile of adult dengue infected patients.
Serologically confirmed 220 adult cases of dengue infections admitted to Mayo hospital from June 2013 to November 2013 were classified as having dengue fever, dengue haemorragic fever and dengue shock syndrome. The frequency and range of bilirubin, liver enzymes derangement and presence of liver enlargement in each group was calculated and further stratified according to age and gender. Patients with positive viral serology, chronic liver disease, malaria and typhoid were excluded from the study.
About 60% of DHF patients had hepatomegaly compared to 40% of DF patients. Liver dysfunction was more common in DF compared to DHF (38.15 vs 18.6%). Hyperbilirubinemia was noted in 40 (18.2%) patients, 28 (12.7%) in DF and 12(5.5%) in DHF. The mean serum bilirubin was higher in DHF [0.87+0.33] compared to DF [0.74+0.27]. Bilirubin was higher in male patients and in younger (<20 years) age group. ALT was elevated more frequently in male patients in age group of 31-40 years and in DF patients as compared to DHF [72(32.7% vs 40(18.2%)]. The mean serum ALT level was 103.7 U/l in DHF and 69.2U/l in DF. AST was raised in all DHF patients as compared to DF in which 40% patients had normal AST levels. Alkaline Phosphate was high in all DHF patients with a mean of 278.7. It was raised in most of the DF patients as well and majority of patients were in age group of 31-40 years.
Liver involvement is very common in dengue infections and is not limited to elevation of transaminases only. Bilirubin and Alkaline phosphatase are also raised in considerable number of patients. Therefore in adults with fever, jaundice, hepatomegaly and altered liver function tests, the diagnosis of dengue infection should be strongly considered in areas where dengue infection is endemic. Dengue Fever Dengue Hemorrhagic Fever Dengue Shock Syndrome Disseminated intravascular coagulation Alanine transaminase Aspartate aminotransferase.
通过评估成年登革热感染患者的临床和生化特征，估计登革热感染时肝脏受累的范围。
对2013年6月至2013年11月入住梅奥医院的220例血清学确诊的成年登革热感染病例，根据病情分为登革热、登革出血热和登革休克综合征。计算每组胆红素、肝酶紊乱的频率和范围以及肝脏肿大的情况，并根据年龄和性别进一步分层。将病毒血清学阳性、患有慢性肝病、疟疾和伤寒的患者排除在研究之外。
约60%的登革出血热患者有肝肿大，而登革热患者为40%。与登革出血热相比，登革热患者肝功能障碍更为常见（38.15%对18.6%）。40例（18.2%）患者出现高胆红素血症，登革热患者28例（12.7%），登革出血热患者12例（5.5%）。登革出血热患者的平均血清胆红素[0.87 + 0.33]高于登革热患者[0.74 + 0.27]。男性患者和年龄较小（<20岁）的年龄组胆红素水平较高。与登革出血热患者相比，31 - 40岁年龄组的男性患者和登革热患者谷丙转氨酶升高更为频繁[72例（32.7%）对40例（18.2%）]。登革出血热患者的平均血清谷丙转氨酶水平为103.7 U/l，登革热患者为69.2 U/l。与登革热患者相比，所有登革出血热患者谷草转氨酶均升高，登革热患者中有40%谷草转氨酶水平正常。所有登革出血热患者碱性磷酸酶均升高，平均为278.7。大多数登革热患者碱性磷酸酶也升高，大多数患者在31 - 40岁年龄组。
肝脏受累在登革热感染中非常常见，且不仅限于转氨酶升高。相当数量的患者胆红素和碱性磷酸酶也会升高。因此，在登革热感染流行地区，对于出现发热、黄疸、肝肿大和肝功能检查异常的成年人，应高度考虑登革热感染的诊断。登革热、登革出血热、登革休克综合征、弥散性血管内凝血、谷丙转氨酶、谷草转氨酶
