哥伦比亚南部 2019-2020 年登革热爆发期间儿童严重登革热噬血细胞淋巴组织细胞增生症的临床和实验室特征。

Clinical and Laboratory Characteristics of Hemophagocytic Lymphohistiocytosis in Children With Severe Dengue During the 2019-2020 Outbreak in Southern Colombia.

机构信息

From the Departamento de Pediatría, Facultad de Salud, Universidad Surcolombiana, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia.

Departamento de Medicina Social y Salud Familiar, Facultad Ciencias de la Salud, Universidad del Cauca, Popayán, Cauca, Colombia.

出版信息

Pediatr Infect Dis J. 2023 Jun 1;42(6):e204-e211. doi: 10.1097/INF.0000000000003887. Epub 2023 Mar 3.

DOI:10.1097/INF.0000000000003887

PMID:36916863

Abstract

BACKGROUND

Hemophagocytic lymphohistiocytosis (HLH) is characterized by uncontrolled activation of inflammatory cells and an exaggerated release of cytokines. It can be triggered by different factors, including viruses, such as dengue. The objective of this study was to characterize the clinical and laboratory profiles of children with severe dengue and HLH, and to identify the risk factors for this clinical complication.

METHODS

An analytical study was conducted in children with severe dengue who were treated in an intensive care unit between January 2019 and March 2020. Clinical and laboratory factors were compared between patients with and without HLH.

RESULTS

HLH represented 13.4% (15/112) of children with severe dengue. Patients with HLH had a long-lasting fever (10.1 vs. 5.8 days; P = 0.012), low hemoglobin levels (7.6 vs. 10.8 g/dL; P = 0.000) and high aspartate aminotransferase values (4443 vs. 1061 U/L; P = 0.002), alanine transaminase (1433 vs. 487 U/L; P = 0.004), partial thromboplastin time (80.6 vs. 51.8 seconds; P = 0.010), prothrombin time (23.5 vs. 19.6 seconds; P = 0.024), triglycerides (333.7 vs. 223.2 mg/dL; P = 0.005), lactate dehydrogenase (4209 vs. 1947 U/L; P = 0.006), soluble CD25 (3488 vs. 1026 pg/mL; P = 0.014), and presented with higher frequency of myocarditis (66.7% vs. 38.3%; P = 0.048), hepatitis (5.3% vs. 1.3%; P = 0.014), bacterial coinfection (73.3% vs. 26.7%; P = 0.010) and fatal outcome (26% vs. 5%; P = 0.037).

CONCLUSIONS

HLH is a serious life-threatening clinical complication of dengue virus infection that must be considered, particularly during outbreaks.

摘要

背景

噬血细胞性淋巴组织细胞增生症（HLH）的特征是炎症细胞失控激活和细胞因子过度释放。它可由不同的因素触发，包括病毒，如登革热。本研究的目的是描述重症登革热合并 HLH 患儿的临床和实验室特征，并确定这种临床并发症的危险因素。

方法

在 2019 年 1 月至 2020 年 3 月期间，对重症登革热并入住重症监护病房的患儿进行了一项分析性研究。比较了 HLH 患儿与非 HLH 患儿的临床和实验室因素。

结果

HLH 占重症登革热患儿的 13.4%（15/112）。HLH 患儿发热时间长（10.1 天 vs. 5.8 天；P=0.012），血红蛋白水平低（7.6 g/dL vs. 10.8 g/dL；P=0.000），天门冬氨酸转氨酶（4443 U/L vs. 1061 U/L；P=0.002）、丙氨酸转氨酶（1433 U/L vs. 487 U/L；P=0.004）、部分凝血活酶时间（80.6 秒 vs. 51.8 秒；P=0.010）、凝血酶原时间（23.5 秒 vs. 19.6 秒；P=0.024）、甘油三酯（333.7 mg/dL vs. 223.2 mg/dL；P=0.005）、乳酸脱氢酶（4209 U/L vs. 1947 U/L；P=0.006）、可溶性 CD25（3488 pg/mL vs. 1026 pg/mL；P=0.014）较高，心肌炎（66.7% vs. 38.3%；P=0.048）、肝炎（5.3% vs. 1.3%；P=0.014）、细菌合并感染（73.3% vs. 26.7%；P=0.010）和病死率（26% vs. 5%；P=0.037）较高。