登革熱病人之上消化道內視鏡變化與臨床

近一年來登革熱在台灣流行，1988年9月至11月，共收集76位臨床診斷登革熱患者接受胃十二指腸鏡檢查，部份患者並接受胃切片病理檢查，且同期間有腸胃症狀而接受上消化道內視鏡檢查者655例為對照群，兩者比較之。分析項目包括內視鏡變化，血小板數量，內視鏡檢查前服用藥物之影響，臨床症狀，病理發現及病程時間。其結果發現： (1)內視鏡像有出血性胃炎之變化者高達58.5%與一般檢查群之8.9%呈有意義差別(p＜0.005)。 (2)76位患者中血小板低於5萬者或高於5萬者，其上消化道出血分別佔48.6%、29.7%(p＜0.025)。 (3)在鏡檢前曾因發燒頭痛而服用藥物者，其血小板數比未服用藥物者為低且上消化道出血比率較高，分別為40.6%、26%(p＜0.025)。 (4)上消化道出血於發病4天以後發生者較多，尤其未服用藥物者更在5～6天以後發生。 (5)上消化道出血和上腹痛及皮膚疹無關(p＞0.90、p＞0.10) (6)內視鏡像為出血性胃炎或表淺性胃炎加血性胃炎者，其出血比率稍高，但統計學上並無意義。 (7)胃切片病理顯示34%(12/35)有黏膜下充血或出血現象，其中一例有服藥，八例未服藥物。 (8)患者中並無連續性登革熱感染(sequential dengue-infection)的病例，至於登革熱引能消化道出血之機轉有待進一步研究。

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無資料

並列摘要

The following is a report of the recent Dengue Fever epidemic in Southern Taiwan. From Sept, 1988 to Nov, 1988, 76 patients were clinically diagnosed with fever, leucopenia, thrombocytopenia and other classical signs and symptoms of Dengue Fever. Among them 26 cases were proven by serology. Analysis and discussion were emphasized on the gastroduodenoscopic findings, histopathologic findings and relationship between upper gastrointestinal tract bleeding and thrombocytes, oral medication and clinical symptoms. 655 patients having undergone endoscopy within the same period were used as a control group. It was concluded that: 1) 58.5% of the Dengue Fever Group disclosed hemorrhagic gastritis in their endoscopic findings and in the control group only 8.9% was noted. 2) Patients with thrombocytes less than 50000/mmc suffered from UGI bleeding at a detection rate of around 48.6%. On the other hand, the detection rate was around 29.7% in those patients with thrombocytes over 50000/mmc. Thus a significant difference was shown (p＜0.025). 3) The thrombocyte count decreased significantly in patients who had had oral medication before endoscopy compared to those without oral medication. The detection rate of UGI bleeding was 40.6% and 26% respectively (p＜0.025). 4) Most upper G-I bleeding cases occurred after the 4th day of onset, especially in the group without oral medication. 5) There was no significant relationship between UGI bleeding and symptoms of epigastralgia or cutaneous eruption. 6) In cases of presenting hemorrhagic gastritis and superficial plus hemorrhagic gastritis by endoscopy, the detection rate of UGI bleeding seemed higher but there was no statistical difference. 7) The pathology of endoscopic biopsy showed that 34% (12/35) of patients had submucosa congestion or hemorrhage. 8) There was no Sequential Secondary Dengue Infection in any patient in this study.

並列關鍵字

gastroduodenoscopy ； dengue fever ； hemorrhagic gastristis

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登革熱病人之上消化道內視鏡變化與臨床

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