肝脏受累是一种罕见但经常被忽视的登革热并发症。对于有效的临床管理至关重要,登革热相关肝脏受累的早期诊断依赖于对其临床和生物学特征的准确描述,其预后因素,它与严重登革热的关系及其临床管理。我们通过搜索PubMed和WebofScience数据库进行了系统评价,以获取原始病例报告,报告登革热相关肝脏受累的临床和/或生物学特征的队列和横断面研究.该研究在PROSPERO(CRD42021262657)中注册。在确定的2552篇文章中,167人被包括在内。登革热相关的肝脏受累的临床特征包括腹痛,肝肿大,黄疸,恶心/呕吐,和回声肝脏表现出肝细胞坏死和轻微的炎症。天冬氨酸氨基转移酶和丙氨酸氨基转移酶升高,但胆红素升高,碱性磷酸酶,γ-谷氨酰转移酶,国际标准化比率增加,肌酐和肌酸激酶,在登革热相关肝脏受累中,白蛋白降低,凝血酶原和活化部分凝血活酶时间延长.心血管和血液系统经常受到影响,翻译与严重登革热有很强的联系。肝脏受累在男性和老年人中更为常见。它与登革热病毒血清型2和继发感染有关。早期服用扑热息痛会增加肝脏受累的风险,其中临床管理大多是保守的。总之,本系统综述表明,早期监测转氨酶,临床评估,和超声检查可以有效诊断登革热相关的肝脏受累,能够早期识别和管理严重的登革热。
Liver involvement is an unusual yet frequently overlooked dengue complication. Pivotal for an efficient clinical management, the early diagnosis of dengue-associated liver involvement relies on an accurate description of its clinical and biological characteristics, its prognosis factors, its association with severe dengue and its clinical management. We conducted a systematic
review by searching PubMed and Web of Science databases for original case reports, cohort and cross-sectional studies reporting the clinical and/or biological features of dengue-associated liver involvement. The study was registered in PROSPERO (CRD42021262657). Of the 2552 articles identified, 167 were included. Dengue-associated liver involvement was characterised by clinical features including abdominal pain, hepatomegaly, jaundice, nausea/vomiting, and an echogenic liver exhibiting hepatocellular necrosis and minimal inflammation. Elevated Aspartate Aminotransferase and Alanine Aminotransferase but also elevated bilirubin, Alkaline Phosphatase, gamma-glutamyl transferase, increased International Normalised Ratio, creatinine and creatine kinase, lower albumin and prolonged prothrombin and activated partial thromboplastin time were prevalent in dengue-associated liver involvement. Cardiovascular and haematological systems were frequently affected, translating in a strong association with severe dengue. Liver involvement was more common in males and older adults. It was associated with dengue virus serotype-2 and secondary infections. Early paracetamol intake increased the risk of liver involvement, which clinical management was mostly conservative. In conclusion, this systematic
review demonstrates that early monitoring of transaminases, clinical assessment, and ultrasound examination allow an efficient diagnosis of dengue-associated liver involvement, enabling the early identification and management of severe dengue.