成人传染性单核细胞增多症70例临床分析

Clinical analysis of infectious mononucleosis in 70 adult patients

目的探讨成人传染性单核细胞增多症(infectious mononucleosis,IM)的临床表现。方法回顾性分析2006年6月—2012年6月在复旦大学附属华山医院住院治疗的70例IM患者的病例资料。结果成人IM呈全年散发,患者年龄(31.4±13.9)岁,男性略多于女性。患者均有发热,其中70.0%有咽峡炎,68.6%脾大,65.7%淋巴结肿大,29.0%皮疹,15.7%肝大,11.4%头痛。血常规检查50.0%的患者白细胞升高,81.4%的患者淋巴细胞比例>35%,42.9%的患者外周血涂片异形淋巴细胞>30%,84.3%的患者血小板正常。92.9%的患者肝功能异常,47.1%的患者ALT>5倍正常值上限(upper limit of normal,ULN),但仅有8.6%的患者TBIL>2×ULN。1例出现肾功能异常。血清学检测EBV IgM阳性率为50.0%,EBV IgG阳性率为91.7%。EBV DNA载量中位数为4.1 log10copies/ml。患者住院天数(11.6±6.8)d。2例慢性活动性EBV感染者死亡,治愈率为92.9%。结论 IM为自限性疾病,不必常规应用糖皮质激素和抗病毒药物,且预后良好,但慢性活动性EBV感染者预后差。

Objective To investigare the clinical features of infectious mononucleosis （IM） in adult patients. Methods The clinical data of 70 adult patients with IM, who were hospitalized in Huashan Hospital Affiliated to Fudan University, from Jun. 2006 to Jun. 2012, were analyzed retrospectively. Results IM could occur in adults during the whole year. The average age of the patients was 31.4±13.9 years old, and male patients were slightly more than female patients. All the patients had fever, while 70.0% of them had agina, 68.6% splenomegaly, 65.7% lymph node enlargement, 29.0% skin rash,15.7% hepatomegaly and 11.4% headache. WBC increased in 50.0% of the patients, the proportion of lymphocytes was more than 35% in 81.4% of the patients, the proportion of atypical lymphocytes was more than 30% in 42.9% of the patients, and PLT were normal in 84.3% of the patients. Liver function was abnormal in 92.9% of the patients. ALT level was above 5 times upper normal limit （ULN） in 47.1% of the patients, but TBIL was above 2 times ULN only in 8.6% of the patients. One patient had abnormal renal function. Epstein-Barr virus （EBV） IgM was positive in 50.0% of the patients and EBV IgG was positive in 91.7% of the patients. The median EBV DNA load was 4.1 log 10 copies/ml. The average hospitalization days were 11.6 ±6.8 days. Two patients with chronic active EBV infection were died, and the curative rate was 92.9%. Conclusions IM is a self-limiting disease, and is no need using corticosteroid or antiviral drugs as a rou-tine treatment. Generally, the prognosis of IM is good, but prognosis of chronic active EBV infection is poor.