儿童EB病毒感染传染性单核细胞增多症的临床特征

Clinical Characteristics of Infectious Mononucleosis Associated with Epstein-Barr Virus Infection in Children

目的探讨儿童EB病毒(EBV)感染传染性单核细胞增多症(IM)的临床特征。方法收集首都医科大学附属北京儿童医院2007年1月-2008年10月符合EBV感染IM诊断标准的住院患儿150例。按年龄分<6岁组和≥6岁组。比较二组患儿的临床症状、体征、实验室检查和并发症的发生率。结果 150例患儿中男86例,女64例;中位数年龄为6岁(11个月～17岁),其中<6岁71例(占47.3%),≥6岁79例(占52.7%)。发热、颈淋巴结大和扁桃体炎是IM患儿的主要临床表现,其阳性率分别为82.7%、94.7%和88.7%,肝大、脾大、皮疹和眼睑水肿的发生率分别为50.7%、46.0%、14.0%和16.7%。<6岁组肝大和脾大的发生率显著高于≥6岁组(P=0.001,0.002),<6岁组患儿外周血WBC计数高于≥6岁组(P=0.010);≥6岁组ALT和AST高于<6岁组(P=0.047,0.028)。二组常见的并发症主要有肺炎、肝损害、心肌损害、血小板减少和中性粒细胞减少,≥6岁组肝损害的发生率显著高于<6岁组(P=0.036)。结论不同年龄段儿童EBV感染IM的临床症状、体征、实验室检查及并发症存在差异。学龄前儿童肝脾大的发生率较高,WBC计数较高;而学龄期儿童肝酶升高的程度更重,肝损害的发生率更高。

Objective To explore the clinical characteristics of infectious mononucleosis（IM）associated with Epstein-Barr virus（EBV） infection in children.Methods One hundred and fifty hospitalized patients with EBV-IM were enrolled from Jan.2007 to Oct.2008 in Beijing Children′s Hospital Affiliated to Capital Medical University.All patients were divided into 2 groups as younger than 6 years old group（group Ⅰ） and more than or equal to 6 years old group（group Ⅱ）.The clinical symptoms,signs,laboratory examinations and the incidence of complications between 2 groups were compared.Results Totally 150 patients were enrolled,with 86 boys and 64 girls,and the me-dian age was years old,ranging from 11 month to 17 years old.Patients in group Ⅰ accounted for 47.3%,and in group Ⅱ accounted for 52.7%.Fever,lymphadenopathy and pharyngitis were main manifestations of the patients with EBV-IM,these incidence rate were 82.7%,94.7% and 88.7%,respectively.Incidence of splenomegaly,hepatomegaly,rash and puffy eyelid were 50.7%,46.0%,14.0% and 16.7%,respectively.The incidence rates of splenomegaly and hepatomegaly in group Ⅰ were higher than those in group Ⅱ（P=0.001,0.002）.The counts of WBC in group Ⅰ was higher than that in group Ⅱ（P=0.010）.ALT and AST in group Ⅰ were lower than those in group Ⅱ（P=0.047,0.028）.The common complications of 2 groups were pneumonia,hepatic lesion,myocardial damage,thrombocytopenia and neutrocytopenia.The incidence of hepatic lesion in group Ⅱ was even higher than that in group Ⅰ（P=0.036）.Conclusions Clinical symptoms,signs,laboratory examinations and complications of patients with EBV-IM varied in different ages had differences.The preschool patients usually had high incidence of hepatosplenomegaly and higher counts of WBC,but the school-age patients had higher liver enzyme and hepa-tic lesion.