Rabbani M U, Aslam Mohd, Zaheer M S, Ashraf Muhammad Uwais
Professor.
Assistant Professor, JN Medical College, AMU, Aligarh, Uttar Pradesh.
J Assoc Physicians India. 2018 Apr;66(4):37-9.
The present study was done to ascertain the presentations of dengue fever in a North Indian tertiary care Hospital, and to compare the clinical and laboratory features among patients with and without warning signs in dengue fever.
A total of 600 patients of dengue admitted to medical wards were included in the study. A detailed history as well as a general and systemic clinical examination were carried out. Haematological profiles and biochemical investigations were done at the time of admission and were followed daily or at times twice a day. Signs of plasma leakage were assessed by chest radiograph and abdominal ultrasonography, serum albumin etc. Patients were classified as dengue fever without warning signs and with warning signs and laboratory diagnosis of dengue was established by demonstration of NS1 antigen and specific antibodies to dengue in serum.
Of the 600 dengue positive patients, 421 (70.2%) were males and 179 (29.8%) were females. Mean age of the patients was 27.35±11.43 years. Among all patients of dengue, 21 (3.5%) presented with bleeding from any site. Out of these, only 7 of those presenting without warning signs had bleeding episodes whereas, 22 (34.3%) of patients presenting with warning signs had bleeding and this difference was statistically significant (p=0.01). Haematocrit was an important factor to predict severity of dengue. Whereas the mean haematocrit among all patients was 39.79±3.23%, it was 39.49±4.25% among those without warning signs and 42.22±3.54% among those with warning signs of dengue, and this was significant statistically, with a p-value of 0.002.
Early diagnosis, monitoring and prompt supportive management can reduce mortality in dengue. In the present study, it was found that newer signs and symptoms are emerging and may cause delay in the diagnosis. It was found that the mortality rate was significantly higher in patients of dengue with warning sign.
本研究旨在确定北印度一家三级护理医院中登革热的临床表现，并比较登革热患者中有警告信号和无警告信号者的临床及实验室特征。
本研究纳入了共600名入住内科病房的登革热患者。进行了详细的病史采集以及全面的全身临床检查。入院时进行了血液学检查和生化检测，并每日或有时每日两次进行随访。通过胸部X光片、腹部超声、血清白蛋白等评估血浆渗漏迹象。患者被分为无警告信号的登革热患者和有警告信号的登革热患者，通过检测血清中的NS1抗原和登革热特异性抗体来确立登革热的实验室诊断。
在600名登革热阳性患者中，421名（70.2%）为男性，179名（29.8%）为女性。患者的平均年龄为27.35±11.43岁。在所有登革热患者中，21名（3.5%）出现了任何部位的出血。其中，无警告信号的患者中只有7名有出血发作，而有警告信号的患者中有22名（34.3%）出现出血，且这种差异具有统计学意义（p=0.01）。血细胞比容是预测登革热严重程度的一个重要因素。所有患者中的平均血细胞比容为39.79±3.23%，无警告信号的患者中为39.49±4.25%，有登革热警告信号的患者中为42.22±3.54%，这在统计学上具有显著性，p值为0.002。
早期诊断、监测和及时的支持性治疗可降低登革热的死亡率。在本研究中，发现新的症状和体征正在出现，可能导致诊断延迟。发现有警告信号的登革热患者死亡率显著更高。
