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目的了解登革热早期临床特点,探讨登革热早期实验室诊断指标。方法收集疑似病例的人口学、临床和实验室资料,采集其血标本进行IgM、IgG抗体和反转录酶-聚合酶链反应(reverse transcription-polymerase chainreaction,RT-PCR)检测。采用灵敏度、特异度和约登指数评价临床指标组合。根据相关标准将病例分为确诊组和排除组,比较两组对象各指标含量的差异。结果 291例疑似病例中,确诊208(71.5%)例,其中出现发热、头痛、皮疹、关节痛、颜面潮红、胸部发红和出血症状的患者分别占97.7%、85.4%、61.9%、77.8%、9.5%、16.7%和16.7%。确诊组和排除组中,患者关节痛、胸部发红、白细胞异常、血小板异常、肌酸激酶(creatine kinase,CK)和乳酸脱氢酶(lactatedehydrogenase,LDH)异常构成比之间的差异有统计学意义(P<0.05)。白细胞、血小板、CK和LDH单独进行判别时灵敏度分别为60.6%、31.7%、40.5%和55.6%,特异度分别为65.3%、82.7%、77.3%和63.6%。组合判别中,白细胞异常或血小板异常灵敏度最高(65.8%),白细胞和血小板同时异常特异度最高(89.3%),白细胞和血小板中有一项异常且CK和LDH中有一项异常约登指数最高(0.322)。结论血常规和生化检查中异常指标的组合可对登革热病例早期诊断起一定的辅助作用。
Objective To understand the early clinical features of dengue fever and to discuss the diagnostic criteria of dengue early laboratory. Methods The demographic, clinical and laboratory data of suspected cases were collected and their blood samples were collected for IgM, IgG antibodies and reverse transcription-polymerase chain reaction (RT-PCR). Sensitivity, specificity and Youden index were used to evaluate the clinical indicators. The cases were divided into the diagnosis group and the exclusion group according to the relevant standards, and the differences of the indexes of the two groups were compared. Results Of the 291 suspected cases, 208 (71.5%) were diagnosed. Among them, 97.7%, 85.4%, 61.9% and 77.8% of the patients had fever, headache, rash, arthralgia, facial flushing, , 9.5%, 16.7% and 16.7% respectively. Among the diagnosed and excluded groups, there was a statistically significant difference between patients with arthralgia, redness in chest, abnormal white blood cells, abnormal platelet count, abnormal creatine kinase (CK) and lactate dehydrogenase (LDH) Significance (P <0.05). The sensitivities of white blood cells, platelets, CK and LDH alone were 60.6%, 31.7%, 40.5% and 55.6% respectively, and the specificity were 65.3%, 82.7%, 77.3% and 63.6% respectively. Among the combined discriminants, leukocyte abnormalities or platelet abnormalities had the highest sensitivity (65.8%), white blood cells and platelets with the highest abnormal specificity (89.3%), abnormal white blood cells and platelets, and one of the abnormalities in CK and LDH with the highest Youden index (0.322 ). Conclusion The combination of abnormal indexes in blood routine and biochemical tests may play an auxiliary role in the early diagnosis of dengue cases.