小儿传染性单核细胞增多症218例临床特点分析

Clinical analysis of pediatric patients with infectious mononucleosis

目的通过分析传染性单核细胞增多症(IM)患儿的临床特点与实验室检查结果,以提高临床诊断水平。方法回顾性分析2010年1月～2012年3月我院儿科收治的218例IM患儿的临床特点和实验室检查结果。结果本组患儿≤7岁者占86.5%,重症病例25例,死亡2例。临床症状多种多样,以发热、咽峡炎、颈淋巴结炎最常见,肝脏肿大者占61.5%,脾脏肿大占55.5%,眼睑及眶周水肿占25.7%,皮疹占22.5%。实验室检查:95.6%的患儿血液学指标有改变,异型淋巴细胞比例>10%者占91.4%,35.1%的患儿出现血液系统并发症,肝功能损害占61.5%,心肌酶学改变占19.7%,尿常规异常者占16.5%。结论小儿IM临床表现与实验室检查表现复杂,部分病例临床表现不典型,提高对本病实验室结果与临床特点的认识,可减少临床误诊和漏诊。

Objective To analyze the clinical features and laboratory examinations of infectious mononucleosis （IM） and improve its clinical diagnosis. Methods Totally 218 patients with IM admitted to the hospital from January 2010 to March 2012 were analyzed retrospectively. Results The patients aged less than 7 years old accounted for 86.5%, of which, 0,2.5 were severe cases and 2 died. The clinical symptoms included fever, isthmitis and cervical lymphadenitis. Besides, the incidence of hepatomegaly, splenomegaly, blepharo-periorbital edema and rash were 61.5%, 55.5%, 25.7% and 22.5%, respectively. The laboratory examinations showed that 95.6% of IM patients had abnormal hematology indicators; 91.4% of the patients had atypical lymphocyte proportion more than 10% ; 35.1% were combined with hematological complications; 61.5% had liver function damages; 19.7% had abnormal myocardial enzymes and 16.5% had abnormal urine routine examinations. Conclusions The clinical features and laboratory examinations were complicated and diverse in pediatric patients with IM. Some cases had atypical clinical manifestations. The misdiagnosis and missed diagnosis could be avoided through better understanding of such disease.