Hemostatic Changes in Vietnamese Children with Mild Dengue Correlate with the Severity of Vascular Leakage Rather than Bleeding
Hemostatic Changes in Vietnamese Children with Mild Dengue Correlate with the Severity of Vascular Leakage Rather than Bleeding
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DOI：
10.4269/ajtmh.2009.08-0008
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发表时间：
2009-10-01
影响因子：
3.3
通讯作者：
Jeremy Farrar
中科院分区：
文献类型：
--
作者：
Bridget Wills;Tran Van Ngoc;Jeremy Farrar
与登革热相关的出血表现和凝血障碍的潜在机制尚不清楚，部分原因是以前许多关于严重疾病的工作重点没有适当的对照组。我们描述了一大群患有各种严重登革热的儿童和一组类似的非登革热疾病的儿童的详细临床和实验室概况，所有这些都前瞻性地从早期表现到康复。在登革热感染患者中，血小板减少、部分凝血活酶时间增加和纤维蛋白原浓度降低在早期就很明显，并且这些异常与血管渗漏的严重程度和时间密切相关，而与出血的时间无关。几乎没有促凝血剂激活的证据。这些发现不支持弥散性血管内凝血的初步诊断来解释内源性凝血障碍。讨论了另一种生物学上看似合理的假设。
The mechanisms underlying the bleeding manifestations and coagulopathy associated with dengue remain unclear, in part because of the focus of much previous work on severe disease without an appropriate comparison group. We describe detailed clinical and laboratory profiles for a large group of children with dengue of all severities, and a group with similar non-dengue febrile illnesses, all followed prospectively from early presentation through to recovery. Among the dengue-infected patients but not the controls, thrombocytopenia, increased partial thromboplastin times and reduced fibrinogen concentrations were apparent from an early stage, and these abnormalities correlated strongly with the severity and timing of vascular leakage but not bleeding. There was little evidence of procoagulant activation. The findings do not support a primary diagnosis of disseminated intravascular coagulation to explain the intrinsic coagulopathy. An alternative biologically plausible hypothesis is discussed.