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目的:总结34例<3岁婴幼儿登革热的临床特征,为婴幼儿登革热临床诊断提供参考。方法:对2014年9月至12月我院收治的34例<3岁的婴幼儿登革热的临床症状与体征、实验室检查结果、血清免疫学和病原学检查结果、并发症、治疗与转归方面的临床资料进行回顾性分析。结果:所有患儿均有发热,82.4%的患儿发热类型为不规则型;85.3%患儿出现皮疹,合并呼吸道和胃肠道症状较多,较少数出现肝脾肿大;白细胞总数降低患儿占29.4%,血小板降低患儿占41.2%,红细胞比容(HCT)降低患儿占82.4%,凝血酶原时间(PT)缩短患儿占38.2%;丙氨酸氨基转移酶(ALT)轻度升高患儿占8.8%,天冬氨酸氨基转移酶(AST)轻度升高患儿占55.9%;未见伴有总胆红素水平升高患儿;腹部B超、肾功能和心肌酶谱均无异常。发病10 d内,58.8%的患儿DF-Ig M阳性,85.7%为初次感染,24.3%为二次感染,早期检测登革NS1抗原阳性率为29.4%,登革病毒核酸RP-PCR阳性率为32.3%,Ig M检测阳性率为17.6%。11.8%患儿并发支气管炎,20.6%患儿并发肝功能损害,无登革热重症及死亡病例。结论:婴幼儿登革热起病症状较轻、病程短,临床表现为典型登革热为主,合并呼吸道、胃肠道表现及肝功能轻度损害较多,治疗效果好。发病早期应及时检测登革抗原NS1和病毒核酸,有助提高快速诊断率。
Objective: To summarize the clinical features of dengue fever in 34 infants and young children <3 years of age and provide reference for the clinical diagnosis of dengue in infants. Methods: The clinical symptoms and signs, laboratory tests, serum immunology and etiological examination results of 34 cases of infants and children aged <3 years admitted to our hospital from September to December 2014, complications, treatment and outcome The clinical data were retrospectively analyzed. Results: All children had fever, and 82.4% of children had irregular type of fever. A rash appeared in 85.3% of children with more respiratory and gastrointestinal symptoms, a smaller number of hepatosplenomegaly, and a decrease in the total number of white blood cells 29.4% of children, 41.2% of children with thrombocytopenia, 82.4% of children with reduced hematocrit (HCT) and 38.2% of children with shortening of prothrombin time (PT). Alanine aminotransferase (ALT) Mild increase in children accounted for 8.8%, aspartate aminotransferase (AST) increased slightly in children accounted for 55.9%; no increase in children with total bilirubin levels; abdominal B ultrasound, renal function And myocardial enzymes were normal. Within 10 days of onset, 58.8% of the children were positive for DF-IgM, 85.7% were primary infections, 24.3% were secondary infections, the positive rate of dengue NS1 antigen was 29.4%, and the positive rate of dengue virus nucleic acid RP-PCR Was 32.3%, IgM positive rate was 17.6%. 11.8% of children with bronchitis, 20.6% of children with liver dysfunction, no severe dengue and deaths. Conclusion: The incidence of dengue fever in infants and young children is relatively mild with short course of disease. The clinical manifestations are typical dengue fever with mild respiratory and gastrointestinal manifestations and mild damage to liver function. The treatment effect is good. Early detection of dengue antigen should be timely detection of NS1 and viral nucleic acid, help to improve the rapid diagnosis rate.