登革热是由登革病毒引起、经伊蚊叮咬传播的急性传染病，近年来已在全球热带和亚热带地区广泛流行，严重威胁公共卫生安全。目前临床上尚缺乏特异性抗病毒药物和高效的疫苗，临床治疗主要以中西医结合为主要模式，且两者在发病机制阐释、诊疗策略制定等方面各有侧重且互为补充。本文系统梳理登革热西医领域的流行病学特征、病理基础与发病机制及现代医学治疗现状，同时深入阐述中医对该病的病因病机与病位认知、辨证论治体系及中医药治疗进展，旨在为临床诊疗优化与科研方向拓展提供参考。

Dengue fever is an acute infectious disease caused by the dengue virus. In recent years, it has prevailed widely in tropical and subtropical regions, posing a severe threat to public health security. Given the lack of specific antiviral drugs and high-efficiency vaccines for dengue fever, its clinical treatment is predominantly based on integrated traditional Chinese and Western medicine. The two medical systems exhibit distinct focuses and complementary advantages in the interpretation of pathogenesis and the formulation of diagnosis and treatment strategies. This paper systematically reviews the epidemiological characteristics, pathological basis, pathogenesis and current Western medical treatment status of dengue fever, and further elaborates the etiology, pathogenesis, lesion location, syndrome differentiation and treatment system, as well as research progress of traditional Chinese medicine for this disease. It aims to provide references for the optimization of clinical diagnosis and treatment and the expansion of scientific research directions on dengue fever.

目的 分析医院登革热阳性病例特别是重症患者的临床和实验室和流行病学特征可为登革热的早期诊断和预防控制提供依据。方法 收集2010年—2017年期间944例就诊于广州市第一人民医院并经实验室确诊的登革热患者。根据疾病的严重程度将入选患者分为3组,比较各组之间的临床和生物学变量,并使用多元回归分析了严重登革热的危险因素的影响。结果 本研究通过对7年间944例登革热患者进行回顾性分析发现登革热病例以轻症为主,77.5%的患者有基础疾病,主要为糖尿病(15.4%)和高血压患者(34%)。大部分患者就诊时表现为高热(39.05±0.67)℃,登革病毒IgM和(或)IgG阳性,白细胞及血小板减少明显及肝、肾功能异常。重症患者AST和LDH值相比轻症者升高。冠心病和肿瘤疾病的患者发生重症的比例更高。流行趋势分析显示7年间登革热出现1次爆发(2014年)。每年9～10月为登革热高发季节。登革热发病率在男女间无统计学差异。男性和女性的高发年龄分别71～80岁和51～60岁。10岁以下发病率最小,50～80岁年龄段发病率最高。结论 广州市第一人民医院登革热患者以老年人为主,基础性疾病患者是登革热高危人群。登革热患者具有高热、登革病原检测阳性、血象和肝肾功能异常的特征;临床医生在9～10月高发季节加强对高热患者的登革病原检查有利于登革热早期诊断和防治。

Objective The Guangzhou area is a high-risk area for dengue fever. This study aim to provide a basis for the early diagnosis and prevention of dengue fever by analyzing the clinical and laboratory characteristics and epidemiological analysis of dengue patients in Guangzhou,especially in critically ill patients. Methods A total of 944 patients with dengue fever diagnosed at the First People's Hospital of Guangzhou from 2010 to 2017 were collected. The enrolled patients were divided into 3 groups according to the severity of the disease,the clinical and biological variables between the groups were compared,and multiple regression analysis was used to analyze the effects of risk factors for severe dengue. Results This study retrospectively analyzed the clinical manifestations and laboratory tests of 944 patients with dengue fever in the past 7 years,showing that dengue fever cases in Guangzhou are mainly mild. 77.5% of them have underlying diseases,mainly diabetes (15.4%) and hypertension (34%). Most patients developed high fever (39.05±0.67)℃ at the time of seeing doctors,positive for dengue virus IgM and/or IgG,decreased white blood cells and thrombocytopenia,and abnormal liver and kidney function. AST and LDH values were significantly elevated in critically ill patients compared with mild cases. Patients with coronary heart disease and neoplastic disease have a higher proportion of severe cases. Epidemiological analysis of dengue virus showed an outbreak of dengue fever in 7 years (2014). September-October is the season of high incidence of dengue fever. The incidence of dengue fever was not statistically different between men and women. The high-incidence ages of men and women are 71～80 years old and 51～60 years old,respectively. The incidence rate is the lowest under the age of 10,and the highest in the 50～80 age group. Conclusion Dengue fever patients in Guangzhou are dominated by the elderly,and patients with underlying diseases are at high risk of dengue fever. Dengue fever patients have high fever,positive dengue pathogen detection,blood and liver and kidney dysfunction characteristics. Strengthening the dengue pathogen examination for hyperthermia patients during the high season of September-October is conducive to the early diagnosis and prevention of dengue fever.

目的 分析2014年482例广州登革热患者的X线胸片特点,探讨X线胸片对登革热患者的临床诊断价值。方法 选取广州市第一人民医院2014年收治的482例登革热患者作为研究对象,观察分析其X线胸片检查结果的特征。结果 登革热患者X线胸片影像学特点以非特异性的肺纹理增多增粗和斑片渗出灶为主要表现,另有胸膜增厚、胸腔积液和间质性改变。结论 X线胸片检查可以经济、便捷地了解登革热患者的肺部改变,为临床诊断和治疗提供帮助。

Objective To analyze the characteristics of chest X-ray in 482 cases of dengue fever in Guangzhou 2014, and to discuss the diagnostic value of chest X-ray in dengue fever patients. Methods 482 patients of dengue fever patients admitted in Guangzhou First People's Hospital were selected as the research object. The characteristics of the chest X-ray were observed and analyzed. Results The characteristics of chest X-ray images included lung markings thickening increased, exudation, and might lead to pleural thickening, effusion and interstitial change. Conclusion Chest X-ray was a convenient examination for dengue fever patients which had an important diagnostic and therapeutic value.

目的 探讨儿童登革热(DF)合并肝功能损害的临床特征。方法 对2014年8—12月我院感染科收治住院的78例儿童DF的临床资料进行回顾性分析。结果 并发肝功能损害36例(46.15%),其中血清丙氨酸转氨酶(ALT)升高24例(30.77%),血清天冬氨酸转氨酶(AST)升高33例(42.31%);27例(75%)ALT/AST病程2周内恢复正常,9例于1月复查恢复正常。仅有1例总胆红素(TBIL)升高80.8 μmol/L,直接胆红素升高为主,1周后恢复正常。肝功能损害组较无肝功能损害组在外周血白细胞水平、血小板水平差异有统计学意义(P<0.05)。结论 儿童DF并肝功能损害较普遍,以轻度损害为主。与年龄、性别、皮疹、外周血白细胞、血小板有相关性。

Objective To approach the clinical characteristics of children dengue fever combined liver function damage. Methods Clinical data of 78 cases of children dengue fever in our hospital were retrospectively analyzed from August to December in 2014. Results 36 cases (46.15%) complicated with liver function damage. Among them 24 cases (30.77%) of serum alanine aminotransferase (ALT) increased, 33 cases (42.31%) of serum aspartate aminotransferase (AST) increased; 27 cases (75%)ALT/AST returned to normal within 2 weeks, 9 cases were recovered to normal in 1 month. Only 1 cases of total bilirubin (TBIL) increased to 80.8 mol/L, recovered after 1 week. Liver injury group and non liver injury group of peripheral blood leukocytes, platelets level comparison was statistically significant (P<0.05). Conclusion Children dengue fever combined liver function damage was common, mainly mild. There was correlation with age, gender, skin rash, peripheral blood leukocytes and platelets.