Manifestações clínicas e alterações laboratoriais decorrentes da hepatopatia, em pacientes com dengue

Abstract

Este estudo sobre as manifestações hepáticas em pacientes acometidos pelo dengue foi realizado em hospital publico (Professora Esterina Corsini), da Universidade Federal de Mato Grosso do Sul, de janeiro a abril de 2007. As manifestações hepáticas pelo dengue podem evoluir com quadros graves e potencialmente letais. Foram avaliados exames de 68 pacientes atendidos e confirmados com dengue, onde 56 foram classificados como dengue clássico, 6 como dengue hemorrágico grau I e 6 como dengue hemorrágico grau II. Do dengue clássico, 83,3% (45/68) tiveram alterações de Aspartato aminotransferase (AST) e 69,6% (39/68) alterações para Alanino aminotransferase (ALT). No dengue hemorrágico grau I (n=6), AST elevou-se 100% (6/6) e para ALT 83,3% (5/6). No dengue hemorrágico grau II observou-se 100% de alterações tanto para AST, quanto para ALT (6/6). A variação de AST ficou entre 22,0 e 907,0 com média de 164,6 (mediana=96,00). A ALT variou entre 25,0 e 867,0 com média de 166,0 (mediana=105,00). Na análise clínica, 69,1% (47/68) apresentaram náuseas ou vômitos, 51,5% (35/68) dor abdominal e 13,2% (9/68), hepatomegalia. A maioria era adulta jovem (20 - 50 anos), sexo feminino 61,8% (42/68) e sexo masculino 38,2% (26/68). As transaminases elevaram-se mais no sexo feminino. Não houve significância estatística entre náuseas/vômitos, dor abdominal, hepatomegalia com os marcadores referidos. Houve significância entre formas clinicas do dengue e marcadores de função hepática. Conclui-se que a infecção predominou em adultos de baixa renda e escolaridade, sexo feminino, as enzimas hepáticas elevam-se mais no dengue hemorrágico, fraca evidência estatistica entre as manifestações clínicas e as transaminases. Os principais sinais/sintomas clínicos foram febre, cefaléia, mialgia, artralgia, fraqueza, dor retrorbitária, náuseas e vômitos, exantema.

ABSTRACT - This study concerning hepatic disclosures on dengue committed patients was carried out, from January to April 2007 at the Public Hospital of Mato Grosso do Sul Federal University (Hospital Professora Esterina Corsini), in Campo Grande. Hepatic Disclosures caused by dengue may progress to serious proportion and highly lethal. 68 patients were studied concerning hepatic alterations, which 56 reported on classic dengue, 6 as hemorrhagic dengue grade l and 6 as hemorrhagic dengue grade ll. 83.3% (45) out of 56 that reported on classic dengue had AST alterations, and 69.6% (39) had altered ALT. At hemorrhagic dengue grade l (n=6) the AST alterations reached 100% (6/6), and for ALT we had 83.3% (5/6). For hemorrhagic dengue grade ll we have found 100% alterations for AST as much as for ALT (6/6). AST variation reached 22.0 and 907.0, which we had an average value of 164.6 (average=96.00). Regarding ALT we could find a variety between 25.0 and 867.0, which average value was 166.07 (average=105.00). On the evaluation of the clinical signals and symptoms, we have found 69.1% (47/68) reporting nausea and vomit, 51.5% (35/68) reporting on abdominal pain and 13.2% (9/68) reporting hepathomegalie. The average age was mostly young adults (20 to 50 years old), 61.8% (42/68) were female and 38.2% (26/68) male. The transaminasis had increased mostly on female. There hasn’t been any statistic significance among nausea/vomit, abdominal pain, hepathomegalie regarding the referred marking. But there has been statistic significance between dengue clinical shapes and hepathic function markers. We conclude that the infection was predominant adults in low income and education, female, liver enzymes amount to more in dengue hemorrhagic, weak statistical evidence of the clinical manifestations and transaminases. Major signs and clinical symptoms were fever, headache, myalgia, arthralgia, weakness, retrorbitária pain, nausea and vomiting, rash.