儿童传染性单核细胞增多症合并肾损伤26例误诊分析

目的分析儿童传染性单核细胞增多症合并肾损伤误诊病例的临床表现,提高临床医师对本病的认识,利于减少临床误诊。方法回顾性总结2005年5月～2006年8月我院收治26例传染性单核细胞增多症并发肾损伤患儿误诊为肾炎或肾病等临床表现,尿常规及肾功能在治疗前后的动态变化进行分析。结果26例疑诊为肾炎或肾病的患儿中主要症状为眼睑浮肿11例(42.3%)、血尿5例(19.2%)、蛋白尿3例(11.5%)、一过性尿素氮升高1例(3.8%)、肾脏B超改变6例(23.0%),所有病例均给予更昔洛韦抗病毒及对症等治疗7～10d后,随着临床症状的改善,23例指标均恢复正常,3例自动出院未检测。结论传染性单核细胞增多症的并发症常见且多样,可累及多种器官,预后不一。尤其出现血尿、蛋白尿者易误诊为肾炎、肾病综合征等,应引起临床医师的重视,以减少漏诊及误诊的发生。

Objective Mononuclear cells increased childhood infectious disease misdiagnosed cases of renal injury in the clinical manifestations, to improve the clinician＇s awareness of the disease,which will help reduce misdiagnosis. Methods Recalling summarized in May 2005 - 2006, August 26 cases of infectious mononucleosis hospital treated with renal cell histiocytosis nephritis, or kidney damage in children misdiagnosed as other clinical manifestations of renal function and urinary dynamic changes in the hours before and after treatment analysts. Results 26 cases were suspected as the main symptoms of nephritis, or kidney eyelid edema for 11 cases （42.3%）. Hematuria five cases （19.2%）, proteinuria three cases （11.5%）. Increased BUN a sexual one case （3.8%）, renal ultrasonography change in six cases （23.0%）. All patients were treated with gancielovir anti-virus and symptomatic treatment 7-10 days, with the improvement of clinical symptoms. 23 targets were to return to normal, three cases were not detected automatically discharged. Conclusion Infectious disease complications of mononuclear cells more common and varied, involving multiple organ, different prognosis. In particular, there hematuria, proteinuria often misdiagnosed as nephritis, nephritic syndrome, attention should be paid to physicians, to reduce the occurrence of missed diagnosis and misdiagnosis.