儿童传染性单核细胞增多症并发肝损害的临床分析

Clinical analysis of children infectious mononucleosis complicated with hepatic lesion

目的探讨儿童传染性单核细胞增多症并发肝损害的临床特点。方法按照是否并发肝损害将本院收治的112例传染性单核细胞增多症患儿分为肝损害组(32例)和非肝损害组(80例),比较两组患儿的临床症状特点、外周血主要指标水平以及肝功能相关指标变化情况。结果肝损害组患儿肝大和脾大的发生率均显著高于非肝损害组,咽峡炎、浅表淋巴结肿大和皮疹的发生率均显著低于非肝损害组,差异有统计学意义(P<0.05);肝损害组患儿血小板计数(PLT)<100×109/L和异型淋巴细胞>10%的发生率均显著高于非肝损害组,差异有统计学意义(P<0.05);肝损害组患儿天冬氨酸氨基转移酶(AST)升高、丙氨酸氨基转移酶(ALT)升高、直接胆红素(DBiL)升高、总胆红素(TBiL)升高、乳酸脱氢酶(LDH-L)升高、谷氨酰转移酶(GGT)升高、白蛋白(Alb)降低的发生率均显著高于非肝损害组,差异有统计学意义(P<0.05)。结论儿童传染性单核细胞增多症并发肝损害以持续性发热、中重度肝脾大、肝酶异常、血小板减少和异形淋巴细胞增加为主要临床特征,当患儿肝功能明显受损时,应及时确诊并采取有效治疗措施。

Objective To explore the clinical characteristics of children infectious mononucleosis complicated with hep-atic lesion. Methods 112 children with infectious mononucleosis,based on whether they were complicated with hepatic lesion,were allocated to hepatic lesion group （32 patients） and non-hepatic lesion group （80 patients）.Characteristics of clinical symptoms,levels of main indices of peripheral blood and changes of indices of hepatic functions were compared between the two groups. Results Incidences of hepatomegaly and splenomegaly in the hepatic lesion group were higher than those in the non-hepatic lesion group,and incidences of angina,superficial lymph node enlargement and skin rash were lower than those in the non-hepatic lesion group,the differences were significant （P〈0.05）;incidences of PLT〈100í109/L and atypical lymphocytes〉10% in the hepatic lesion group were higher than those in the non-hepatic lesion group,the differences were significant （P〈0.05）;incidences of increased AST,increased ALT,increased DBiL,increased TBiL,increased LDH-L,increased GGT and decreased Alb were all higher than those in the non-hepatic lesion group, the differences were significant （P〈0.05）. Conclusion The main clinical characteristics of children infectious mononu-cleosis complicated with hepatic lesion are persistent fever,moderate and severe hepatomegaly and splenomegaly,abnor-mal hepatic enzyme,thrombocytopenia and increased atypical lymphocytes.When obvious damaged hepatic functions are shown in children patients,it is necessary to carry out timely diagnosis and effective treatment.