儿童传染性单核细胞增多症238例临床分析

Clinical analysis of 28 children with infectious monocytosis

目的总结传染性单核细胞增多症(IM)的流行病学、临床表现和实验室检查,以提高该病的临床诊断水平。方法对2002年1月～2006年12月收治的238例儿童IM的流行病学、临床表现及实验室检查等进行回顾性分析。结果1～6岁占82.77%,夏秋季占64.70%。临床表现主要有:发热94.96%,咽峡炎93.70%,鼻塞50.84%,淋巴结肿大94.12%,肝肿大89.50%,脾肿大50.84%,眼睑水肿57.98%。3岁以下鼻塞的发生率明显高于3～14岁,年长儿合并多系统损害的发生率比婴幼儿高。实验室检查:82.35%的患儿外周血异形淋巴细胞(AL)>10%,其中71.94%在病程第2周AL>10%。嗜异性凝集反应(HA)阳性者48.85%,HA阳性率<3岁(14.55%)明显低于≥3岁(53.90%),P<0.05。EBV-VCA-IgM阳性率75.81%,各年龄组间的阳性率无明显差别。结论IM好发于幼儿及学龄前儿童,以夏秋季稍多。眼睑浮肿和鼻塞为IM的重要临床特点。早期及时送检EBV抗体十分必要。

Objective To improve the level of diagnosis of infectious mononucleosis （IM） by summarizing the epidemiology, clinical manifestations and laboratory examinations of the desease. Methods The data of epidemiological surveey, clinical manifestations and laboratory examinations of 238 patients with IM hospitalized from Jan 2002 to Dec 2006 were ana- lyzed. Results 1 ） 82.77% of the patients were in the age group of 1-6 year and 64.70% cases occured in summer and autumn ; 2） The main manifestations of IM were fever （ 94.96% ） , pharyngitis （ 93.70% ） , nasal obstruction （ 50.84% ）, lymphadenopathy （94.12%） , hepatomegaly （89.50%） , splenomegaly （50.84%） and periorbital edema （57.98%）. The incidence of nasal obstruction in children under 3 years of age was higher than that of the children aged 3-14 years. While in school age children, the incidence of the complications in children ≥3 years old was higher than that of the young children. 3）The laboratory test： 82.35% of the patients had atypical lymphocytes（AL） 〉 10%, and among them, 71.94% had AL 〉 10% at the first two weeks of their disease course. 48.85% of the patients had positive heterophil agglutination reaction （HA）. The positive HA rate of children under 3 years old was 14.55 % , lower than that of 53.90% in children older than 3 years （ P 〈 0.05 ）. Positive EBV - VCA - IgM antibodies was observed in 75.81% of the patients , and there was no difference of the positive rate in all age groups. Condusion IM usually occur to infants and preschool children, especially in summer and autumn. Periorbital edema and nasal obstruction are two important features of IM. Anti - EBV antibodies be de- tected as early as possible.