2003至2013年台灣地區登革熱併發登革出血熱危險因子分析

Abstract

背景及目標：登革熱是南高屏地區重要的傳染病，若併發登革出血熱可導致死亡。登革熱併發登革出血熱的致病機轉迄今仍未完全了解。本研究目標為透過流行病學研究釐清登革熱併發登革出血熱的危險因子，以及併發登革出血熱後死亡風險的預測因子。 方法：本研究之研究對象及期間為 2003至2013年間在傳染病個案通報系統登錄之確診本土登革熱及登革出血熱個案。研究設計分成兩部分：(1) 以病例對照研究，探討登革熱併發登革出血熱之危險因子，病例組為研究期間所有確診之登革出血熱個案，對照組則從同期間未併發登革出血熱之登革熱確診個案中，依發病年、發病月、居住縣市配對，以1:4比例隨機選取；(2) 以世代追蹤研究，分析研究期間所有登革出血熱個案的預後，探討死亡的預測因子。 結果：病例對照研究部分共納入 142例登革出血熱病例，及從同時期9,787例登革熱未併發登革出血熱病例中以隨機抽取方式選出的568 位配對病例。多變項條件邏輯式迴歸顯示：60歲以上長者 (OR=4.53 , P<0.0001) 與第二型登革病毒(OR=5.39 , P=0.0081) 是發生登革出血熱的獨立危險因子。世代追蹤研究部分納入研究期間所有142例登革出血熱病例，其中有 42例死亡。多變項條件邏輯式迴歸顯示：60歲以上長者 (OR=3.21 , P<0.027) 及糖尿病患者 (OR=3.08 , P<0.005) 是罹患登革出血熱的預後因子。 結論：本研究結果可提供防治政策參考，對登革出血熱的危險因子及預後因子的知識，協助防疫單位將有限資源聚焦高危險群，提升防治成效。並運用衛教宣導管道，提醒民眾對登革出血熱危險因子及預後因子的正確認知。加強醫事人員之臨床警覺、早期診斷及治療，以提升登革出血熱個案臨床照護、降低死亡率，使登革熱防治工作能有更進一步的突破。

Background and Objectives: Dengue fever is an important infectious disease in southern Taiwan. If complicated with dengue hemorrhagic fever, dengue can lead to death. Currently, the pathogenesis of dengue hemorrhagic fever has not yet been fully understood. The goal of this study was to examine the risk factors of progression to dengue hemorrhagic fever after acquiring dengueinfection, and the predictors of mortality after developing dengue hemorrhagic fever, using epidemiologic study methods. Method: All of the confirmed indigenous dengue fever and dengue hemorrhagic fever cases reported to notificable infectious diseases surveillance system during 2003-2013 were included in this study. The study was divided into two parts. (1) Case-control study that was aimed to examinethe risk factors of progression to dengue hemorrhagic fever after acquiring dengueinfection. Cases included all notified patients with dengue hemorrhagic fever during the study period. Controls were randomly selected from all notified patients with dengue but without hemorrhagic fever during the same period, individually matched by onset month and residential country in 1:4 ratio. (2) Cohort study that retrospectively tracked the outcomes of all notified patients with dengue hemorrhagic fever toanalyze the predictors of mortality. Result: A total of 142 dengue hemorrhagic fever cases and 568 controls were included in the case-control study. Multivariate conditional logistic regression analysis showed that age over 60 years (OR = 4.53, P <0.0001) and infection by type 2 dengue virus (OR = 5.39, P = 0.0081) were two independent risk factors for progression to dengue hemorrhagic fever after acquiring dengueinfection.The 142 dengue hemorrhagic fever cases were included in the cohort study. There were 42 deaths. Multivariate conditional logistic regression analysis showed that the age over 60 years (OR = 3.21, P <0.027) and diabetes mellitus (OR = 3.08, P <0.005) were the twoindependent predictors of mortality after developing dengue hemorrhagic fever. Conclusion: These results enhance our understanding on risk factors and prognostic factors of dengue hemorrhagic fever, and will enablepublic health authority to focus the control effort on the most vulnerable groups. Knowledge on risk factors and prognostic factors will also enable communities and health care professionals to better coordinate the effort on environmental cleansing, personal protection, early diagnosis and treatment of dengue hemorrhagic fever to minimize the dengue-associated morbidity and mortality.