假性EBV和CMV双重感染的传染性单核细胞增多症的临床特点

False dual infection of Epstein-Barr virus and cytomegalovirus in children with infectiousmononucleosis

目的探讨假性EB病毒（EBV）和巨细胞病毒（CMV）双重感染的传染性单核细胞增多症（IM）的临床特点，以及通过临床特点早期识别假性双重感染的临床意义。方法回顾性总结13例CMV-IgM假阳性的由EBV导致IM的临床特点，并将该病例组与确诊的单纯EBV感染导致的IM病例、已证实由EBV和CMV双重感染导致的IM病例分别比较。结果①各组间临床特点比较：发热持续时间、肝肿大及脾肿大的发生率病例组与单纯EBV感染组间差异无统计学意义（均P〉0．05），但这些异常在该二组显著低于双重感染组（P〈0．05或P〈0．01）。IM并发症，如贫血和肺炎的发生率，病例组与单纯EBV感染组间差异无统计学意义（P〉0．05），但该二组的发生率显著低于双重感染组（P〈0．05或P〈0．01）；②各组间实验室指标比较：异型淋巴细胞百分比和肝功能异常的发生率，病例组与单纯EBV感染组间无统计学差异（P〉0．05），但该二组显著低于双重感染组（P〈0．05或P〈0．01）。结论某些IM病例早期存在CMV—IgM假阳性的情况，确诊依赖于针对EBV和CMV的抗体的动态检测。EBV和CMV双重感染者常临床症状较重，故可通过临床症状早期识别假性EBV和CMV双重感染。．

Objective The aim of this study was to explore the characteristics of children with IM suspected for false dual infection of EBV/CMV and the early identification of false positive CMV-IgM through the characteristics of IM. Method The characteristics of 13 patients with IM suspected for the false dual infection of EBV/CMV were retrospectively analyzed and compared with the EBV infection cases and the confirmed dual infection cases of EBV and CMV, respectively. Results ①Clinical manifestations： there were no statistical significance of the duration of fever and the incidence of hepatomegaly and splenomegaly between the false dual infection group and the EBV infection group （ P 〉 0. 05 ）, but the anomalies in these two groups were significantly lower than that in the dual infection group （ P 〈 0. 05 or P 〈 0. 01 ）. Similar results were seen in the comparison of the complications, including anemia and pneumonia, between these groups. ②Laboratory findings：there were no statistical significance of the rate of atypical lymphocyte and the incidence of abnormal liver function between the false dual infection group and the EBV infection group （ P 〉 0.05 ） , but the anomalies in these two groups were significantly lower than that in the dual infection group （P 〈0. 05 or P 〈 0. 01）. Conclusions CMV-IgM test maybe false positive in some cases with IM in the early stage of disease. A definite diagnosis of false dual infection of EBV/CMV can be established by the continuous detection of antibodies against EBV and CMV during follow-up. The cases with dual infection of EBV/CMV often manifest as more severe symptoms. Therefore, early identification of false positive CMV- IgM can be made through the observation of characteristics of IM.