| ObjectiveA series of systematic reviews have shown that the age at onset of dengue will steadily increase over time,disproving the perception that older people are at lower risk of contracting dengue because they have been immunized against the virus at an early age.The Dengue Diagnosis,a health industry standard of the People’s Republic of China,clearly indicates that the elderly are at high risk of severe dengue fever.In recent years,studies at home and abroad have found that atypical symptoms are common in elderly patients with dengue fever,the disease is easy to deteriorate,and medical costs are high.Traditional WHO and domestic guidelines are not sensitive to this diagnosis,and medical strategies need to be paid more attention to.This study retrospectively studied the patients with dengue fever in our hospital,and explored the clinical characteristics of traditional Chinese and western medicine and the influencing factors of disease outcome in the elderly patients with dengue fever,which could provide reference for the diagnosis,treatment and early warning of the elderly patients with dengue fever,and provide the basis for strategic treatment.MethodsDesign database according to dengue fever guidelines and related literature at home and abroad.Collect information of dengue patients and healthy old people for medical examination from June 2014 to December 2019 in Guangdong hospital of Chinese Medicine with outpatient electronic medical records system and hospital system.Observation of the project mainly includes general information(gender,age),clinical characteristics(medical history,symptoms,auxiliary examination,including blood routine,liver and kidney function,myocardial enzyme series,potassiumion,c-reactive protein,calcitonin,presence of lung infection,pleural effusion,peritoneal effusion)and traditional Chinese medicine diagnostic data.The database was imported into SPSS 17.0 for statistical analysis.Chi-square test was used for comparison of enumeration data between groups,t test or non-parametric test was used for comparison of measurement data between groups,and Logistic regression analysis was used for analysis of critical risk factors.Results1.There were 601 subjects in this study,which were divided into three groups:the elderly dengue fever group(301 cases)and the non-elderly dengue fever group(300 cases).The elderly patients were divided into two groups,including 42 patients in the elderly severe dengue fever group and 259 patients in the non-severe dengue fever group.2.Clinical features:(1)Gender:There were 157 females(52.2%)and 144 males(47.8%)in the elderly dengue fever group.There were 173 females(57.7%)and 127 males(42.3%)in the non-elderly dengue fever group.There was no significant statistical significance between gender difference and incidence.(2)Past medical history:The probability of previous hypertension,diabetes,coronary heart disease,cardiac insufficiency,arrhythmia,chronic obstructive pulmonary disease and malignant tumor in the elderly group was higher than that in the non-elderly group(P<0.001),and there was no significant difference in the incidence of chronic renal insufficiency(P>0.05).The probability of previous COPD was significantly higher in the elderly severe group than in the non-severe group(P=0.001).(3)Symptoms:The maximum body temperature of the elderly group was significantly lower than that of the non-elderly group(P<0.001).The incidence of chills,headache,muscle aches,rash,throat discomfort,dry mouth,bitter mouth,diarrhea and loose stool in the non-aged group was significantly higher than that in the non-aged group.The incidence of fatigue,chest tightness,palpitation,cough,gas irritability and constipation in the elderly group was significantly higher than that in the non-aged group(P<0.05).There were no significant differences in nasal obstruction and runny nose,nausea,vomiting,abdominal pain,sweating,poor appetite,poor sleep,black stool and urination among groups(P>0.05).There was no hemorrhage in thoracic and abdominal cavity or vagina in both groups.(4)Assistant examination:The results of WBC,NEUT,LYM,TB,CR,Urea,CRP and PCT in the elderly group were significantly higher than those in the non-elderly group,while the results of HB,HCT,PLT,ALB and K were significantly lower than those in the non-elderly group(P<0.05).Radiologically,no patients had abdominal effusion,and the probability of pulmonary infection in the elderly group was significantly higher than that in the non-elderly group(P<0.001).There were no significant differences in NEUT%,LYM%,ALT,AST,CK,CKMB,LDH and pleural effusion between the two groups(P>0.05).(5)Outcome of disease:Of the 601 dengue patients,65 developed severe cases,of which 42 were elderly patients(64.6%),accounting for 14%of all elderly patients with severe dengue.Three cases died,all of which were elderly patients.3.Analysis of risk factors:The Logistic regression model of severe dengue fever could correctly classify 90.0%of the subjects,with a sensitivity of 32.3%and specificity of 97.5%.In the model,renal insufficiency,COPD and Urea were of statistical significance(P<0.001),and the area under the ROC curve of Urea was 0.736(95%confidence interval:0.664～0.808,P<0.001).The maximum value of Youden index was calculated to be about 0.415,that is,cutoff is 5.32,corresponding sensitivity≈64.1%,specificity≈(1-0.225)=77.5%.Of elderly patients with severe dengue Logistic regression model can correctly classified 89.3%of the research object,and the sensitivity and specificity of the model is 25%and 99.2%.As independent variables,chronic obstructive pulmonary disease and CRP has statistical significance(P<0.001).The area under the ROC curve of CRP was 0.640(95%ci:0.489～0.792,P=0.039),calculated Youden index of the maximum value of 0.329,the cutoff value of 5.32,the corresponding material 47.6%sensitivity and degree of specific material(1-0.147)=85.3%.4.Characteristics of TCM syndromes:The probability of tongue redness,pulse floating and pulse number was higher in the non-elderly group,while the probability of tongue dark redness and pulse string was higher in the elderly patients(P<0.05).There was no significant statistical difference between tongue coating(P>0.05).In terms of the distribution of TCM syndromes,the most common syndromes in the elderly group and non-elderly group were mild heat and dampness depression,disease involving weifen and qifen.The frequency of the syndrome of heat and dampness injuring Yang and Qi without blood intakes and the syndrome of evil unfinished,Qi and Yin injury in elderly patients was more than that of non-elderly patients,while the syndromes of toxic and stasis intermingling,disturbance of movement of blood in non-elderly patients was higher.The syndrome of mild heat and dampness depression,disease involving weifen and qifen was the most common in elderly patients with severe diseases and the syndrome of toxic and stasis intermingling,disturbance of movement of blood was the second.In non-elderly patients with severe dengue,the frequency of the syndrome of heat and dampness injuring Yang and Qi without blood intakes was the highest and the second is the syndrome of toxic and stasis intermingling,disturbance of movement of blood.Conclusion1.Western medicine clinical characteristics:Elderly patients often have underlying diseases,especially chronic obstructive pulmonary disease(COPD),which is an important risk factor for the development of severe dengue fever in the elderly.Elder patients with dengue symptoms are less typical,with black stool and shortness of breath being of particular concern.In terms of laboratory tests,emphasis was placed on changes in UREA and CRP.2.Distribution of Chinese traditional medicine syndromes:Elderly patients are more likely to develop severe disease is based on the internal injury basis of the elderly lack of vital qi and dysfunction of viscera.The surface evil is easy to be introduced into the inside,and the condition is aggravated or even tends to deteriorate.The treatment focuses on removing evil,truncation and preventing transmission. |
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