德宏地区重症登革热患者出现不良预后的临床特征及危险因素分析

Analysis of Clinical Features and Risk Factors of Poor Prognosis in Patients with Severe Dengue Fever in Dehong Area

摘要: 目的：筛选出重症登革热患者出现不良预后的独立危险因素，以期利用快速、准确的预警指标，为减少病情恶化、改善预后、降低登革热的重症率及死亡率提供一定的证据支持。方法：选取2023年01月~2024年01就诊于德宏州人民医院诊断重症登革热的患者，收集纳入对象的临床资料，将收集的数据创建Excel数据库，运用SPSS 26.0软件分析数据。结果：46例患者中，36例经治疗后好转出院，10例患者因治疗效果不佳死亡或因病情危重放弃治疗，登革热预后不良组与好转出院组相比较就诊时症状更严重且年龄较大，住院期间合并出血性并发症、重症肺炎、MODS、第三间隙积液的情况较多，且尿素、肌酐、降钙素、CRP、BNP、ALT、AST、白细胞、PT、APTT水平较高，血红蛋白、血小板水平较低；其中，CRP、白细胞、BNP、ALT、AST、PT、APTT水平升高、血小板水平降低为导致重症登革热患者出现预后不良的独立危险因素。结论：CRP、BNP、ALT、AST、白细胞、PT、APTT水平增高、血小板水平降低可能是重症登革热患者出现预后不良的独立风险，在临床工作中应对以上指标加以关注。

Abstract: Objective: Identifying independent risk factors for poor outcomes in severe dengue fever patients, with the aim of providing evidence-based support for reducing morbidity, improving prognosis, and reducing the incidence of severe dengue fever and mortality through the use of rapid and accurate early warning indicators. Methods: Patients diagnosed with severe dengue fever at Dehong People’s Hospital from January 2023 to January 2024 were selected. Clinical data of the included subjects were collected and used to create an Excel database. The data were then analyzed using SPSS 26.0 software. Results: Among the 46 patients, 36 improved and were discharged after treatment, while 10 patients died due to poor treatment outcomes or had treatment withdrawn because of critical illness. Compared with the group that improved and was discharged, the group with poor prognosis had more severe symptoms at the time of hospital visit and were older. During hospitalization, they had a higher incidence of complications such as hemorrhagic complications, severe pneumonia, MODS, and third-space fluid accumulation. Additionally, levels of urea, creatinine, procalcitonin, CRP, BNP, ALT, AST, white blood cells, PT, and APTT were higher, while levels of hemoglobin and platelets were lower. Among these, elevated levels of CRP, white blood cells, BNP, ALT, AST, PT, and APTT, as well as decreased platelet levels, were identified as independent risk factors for poor prognosis in patients with severe dengue fever. Conclusion: Elevated levels of CRP, BNP, ALT, AST, leukocytes, PT, APTT, and decreased platelet levels may be independent risks of poor prognosis in patients with severe dengue fever, and the above indicators should be paid attention to in clinical work.