中文摘要 背景及目的: 台灣是登革出血熱及登革熱休克症候群的流行地區,糖尿病曾被發表是登革出血熱及登革休克症候群的危險因子,此研究是探討糖尿病是否在登革熱演變過程中扮演重要的角色。 材料及方法: 我們收集了自2002 年一月到十二月所有在高雄醫學大學附設醫院確定診斷是登革熱病人,區分糖尿病及非糖尿病病人,登革熱依嚴重程度分為典型登革熱組,及嚴重登革熱組包括登革出血熱,登革休克症候群以及死亡案例。 結果: 總共有644位病人診斷為登革熱,其中411是典型登革熱,233位病人是嚴重登革熱組, 糖尿病者有65位(典型登革熱28人,嚴重登革熱37人)。我們將病人分為糖尿病組(65人)及非糖尿病組(579人),糖尿病組糖尿病罹病期為8.64±7.3年,發現糖尿病病人年紀較大(平均年齡分別是59.51±9.87 v.s.46.23±18.05歲,p<0.001),體重較重(包括67.38±11.76 v.s. 63.52±14.3公斤,p=0.025),有較多的高血壓病史【32(49.23%) v.s. 100人(17.27%),p<0.001】; 及中風病史【7(10.77%) v.s. 14人(2.42%),p<0.001】;較多的心電圖缺血性心臟變化【13(20%) v.s. 31人(5.35%), p<0.001】較高的住院比例【57(87.69%) v.s. 430人(74.27%),p=0.017】。在實驗室檢查方面,發現糖尿病病人有較高的住院後第四天白血球(6.53±4.82 v.s. 5.07±3.28 *103/μL,p=0.042),及復原值白血球(6.41±1.68 v.s. 5.69±2.08*103/μL,p=0.018), 復原值單核球( 8.25±2.67 v.s.10.36±6.68%,p=0.025 ),以及較低的急診當日血小板(54.54±51.69 v.s. 86.58±63.4*103/μL,p<0.001),住院後第二天血小板(43.98±44.09 v.s. 64.52±45.06*103/μL,p=0.002),及第三天血小板(43.86±35.75 v.s. 62.72±51.21*103/μL,p=0.012),較高的血中纖維蛋白原濃度(428.83±154.6 v.s. 334.41±119.2mg/dl,p=0.027),經多元邏輯回歸分析,發現將年紀及曾得過登革熱病史等兩因素排除之後,男性(Odds ratio=1.53,95% Confidence Interval=1.03~2.77,p=0.037)及糖尿病(Odds ratio=2.11, 95% Confidence Interval=1.13~3.93,p=0.019)兩因素是造成嚴重登革熱的危險因子。在糖尿病族群中,嚴重型登革熱組糖尿病的罹病期較長(10.44±8.15v.s. 6.33±5.26年,p=0.017),但血糖(222.86±110.36 v.s. 209.04±95.09 mg/dl,p=0.596)及糖化血色素(8.49±1.64 v.s. 8.82±2.18 %,p=0.580)無差異,另外糖尿病病人及非糖尿病病人死亡率無差異【3/65(4.62%)v.s. 8/579 (1.38%),p=0.056】。 結論: 我們發現男性及糖尿病兩因素是造成嚴重登革熱的危險因子,在糖尿病族群中,糖尿病罹病期長短是影響登革熱嚴重程度的因素。
英文摘要 Background and Purpose: We investigated the relationship between dengue fever (DF), dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), and diabetes mellitus(DM) in southern Taiwan. Methods: This is a retrospective study of patients serologically proved at a university hospital during an outbreak of DF in Taiwan in 2002 , including OPD and admission patients. Results: There are total 644 patients, 411 of them are DF patients and 233 are DHF/DSS/Death patients. 65 of them are DM patients, DM patients are older(59.51±9.87 v.s. 46.23±18.05 years , p<0.001) , more obese (BW 67.38±11.76 v.s. 63.52±14.3 Kg,p=0.025), had more HTN【32/65 (49.23%) v.s. 100/579 (17.27%),p<0.001】;and old CVA history【7/65(10.77%) v.s. 14/579(2.42 % ) , p<0.001 】; more ECG ischemia finding(%) 【13/65(20%)v.s.31/579 (5.35%), p<0.001】, more hospitalization rate【57/65(87.69%) v.s. 430/579(74.27%) , p=0.017 】。Higher WBC count on day 4 after admission(6.53±4.82 v.s. 5.07±3.28 *103/μL,p=0.042),and recovery WBC count(6.41±1.68 v.s. 5.69±2.08*103/μL, p=0.018 ) , lower recovery monocyte ( 8.25±2.67 v.s. 10.36±6.68%,p=0.025), lower PLT count at ER (54.54±51.69 v.s.86.58±63.4*103/μ,p<0.001), PLT-day-2(43.98±44.09 v.s. 64.52±45.06*103/μL,p=0.002),and PLT day-3(43.86±35.75 v.s. 62.72±51.21*103/μL,p=0.012), Higher plasma fibrinogen level(428.83±154.6 v.s. 334.41±119.2mg/dl ,p=0.027),Multiple logistic regression analysis revealed after adjusted for age and previous dengue history, male gender (Odds ratio=1.53 , 95% Confidence Interval=1.03~2.77,p=0.037)and diabetes(Odds ratio=2.11,95% Confidence Interval=1.13~3.93,p=0.019)are two risk factors for DHF& DSS& death. In diabetic patients, DM duration is a risk factor for DF severity (10.44±8.15 v.s.6.33±5.26 years , p=0.017) , but neither blood sugar(222.86±110.36 v.s.209.04±95.09 mg/dl,p=0.596)nor HbA1c(8.49±1.64 v.s. 8.82±2.18 %,p=0.580)is,The mortality rate between DM and non-DM groups is no difference.【3/65(4.62%) v.s. 8/579(1.38%),p=0.056】. Conclusion: DM and male gender are two risk factors for the development of DHF/ DSS. DM duration is an important risk factor for DF severity in diabetic patients.