EB病毒相关传染性单核细胞增多症102例临床分析

Retrospective analysis of 102 cases Epstein-Barr virus-associated infectious mononucleosis

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，以提高临床诊断水平。方法收集2012年1～12月南京医科大学附属南京儿童医院收治符合EBV感染IM诊断标准的102例患儿，将102例EBV-IM患儿分成＜3岁、3～6岁、≥7岁3组，对这三组临床资料进行回顾性分析。结果102例中，男女比例1.3∶1；＜3岁35例（34.3%），3～6岁46例（45.1%），≥7岁21例（20.6%）。临床表现多种多样，其中发热、咽峡炎和淋巴结肿大是 IM 患儿的主要临床表现，其阳性率分别为100%、93.1%和75.5%；肝大、脾大、皮疹和眼睑水肿的发生率分别为45.1%、37.3%、30.4%和16.7%，以上临床表现在三个年龄组之间差异无统计学意义（P＞0.05）。外周血白细胞年幼儿升高明显，异型淋巴细胞各年龄组无明显差异，血清ALT、AST在年长儿偏高。结论 EBV-IM起病症状多样，可累及全身多个系统，结合临床表现及检测EBV-DNA、EBV抗体有助于早期诊断。

Objective To explore the clinical features of Epstein-Barr virus（EBV）-associated infectious mononucleosis （IM） in children and improve its clinical diagnosis. Methods A retrospective study was conducted in 102 hospitalized patients with EBV-IM who were enrolled from Jan 2012 to Dec 2012 in Nanjing Children＇s Hospital Affiliated to Nanjing Medical University. The patients were divided into 3 age groups： 〈3 years, 3 to 6 years, and≥7 years. We evaluated the recent trend in clinical manifestations and the differences in clinical and laboratory findings among the 3 age groups. Results 102 cases of this group, male to female ratio 1.3∶1;the percent of 〈3-year-old, 3-6-year-old and ≥7-year-old was 34.3%, 45.1%, 20.6%. Fever, pharyngitis and lymphadenopathy were main manifestations of the patients with EBV-IM, these incidence rate were 100%, 93.1%and 87.7%, respectively. Incidence of splenomegaly, hepatomegaly, rash and puffy eyelid were 45.1%, 37.3%, 30.4% and 16.7%, respectively. The differences in the symptoms among the 3 age groups were not statistically significant.The atypical lymphocyte was not difference in the age groups. The leukocyte count was higher in the younger age group. A comparison of ALT, AST elevation among the age groups showed an association with advancing age（P〈0.05）. Conclusion The clinical features and laboratory examinations are complicated and diverse in pediatric patient with EBV-IM.The misdiagnosis and missed diagnosis could be avoided through better understanding of such disease. The diagnostic value of detection of EBV specific antibodies and EBV-DNA in serum should be emphasized.