EB 病毒合并肺炎支原体感染传染性单核细胞增多症的临床特征分析

Clinical characteristics of infectious mononucleosis with Epstein -Barr virus and mycoplasma pneumoniae ;infection in children

目的：探讨儿童 EB 病毒（EBV）合并肺炎支原体（MP）感染传染性单核细胞增多症（传单）的临床特征。方法选择 EBV 检测阳性的传单患儿，按照 MP 检测结果分为 EBV ＋MP 组和 EBV 组，比较两组的临床表现、实验室指标和转归。结果61例儿童传单中有18例（29．51％）为 EBV 合并 MP 感染，其平均年龄为（4．44±2．75）岁，显著大于 EBV 组的（2．90±2．08）岁（t ＝2．401，P ＝0．02）。EBV ＋MP 组中重度扁桃体肿大、肝肿大和并发症（尤其是咳嗽和消化道症状）的比例（分别为88．89％、55．56％和72．22％）显著高于EBV 组（分别为48．84％、13．95％和44．19％）（χ2＝8．529、10．719、3．999，P ＝0．003、0．001、0．046）。EBV ＋MP 组与 EBV 组比较，外周血白细胞[（18．17±7．17）×109／L 比（13．70±7．12）×109／L]、淋巴细胞计数[（11．61±6．04）×109／L 比（7．65±4．82）×109／L]、异型淋巴细胞[（20．69±13．03）％比（13．00±11.20）％]和谷氨酰转肽酶水平[（99．41±91．20）U ／L 比（47．95±69．22）U ／L）]更高（t ＝2．231、2．716、2.215、2．239，P ＝0．029、0．009、0．031、0．029）。两组住院时间及各症状体征恢复时间差异无统计学意义。结论儿童 EBV 合并 MP 感染传单不少见且多见于年长儿，与 EBV 比较，中重度扁桃体肿大、肝肿大、并发症更常见，淋巴细胞及异型淋巴细胞水平更高，但疗效转归无差异。传单儿童应常规检测 MP，对于 EBV 合并MP 感染病例，早诊断早治疗，预后良好。

Objective To explore the clinical characteristics of infectious mononucleosis （IM）with Epstein-Barr virus （EBV）and mycoplasma pneumoniae （MP）infection in children.Methods Children with IMwho were all positive for EBV and hospitalized in our department from January 2008 to July 2015 were included and divided into the EBV ＋MP group and the EBV group according to the results of MP.The manifestations,laboratory variables and outcomes were compared in the two groups.Results Of all these 61 cases,18 children （29.51%）were accompanied with EBV and MP infection.The age of the EBV ＋MP group was older than the EBV group [（4.44 ±2.75）vs （2.90 ± 2.08）years,t =2.401,P =0.02].Moderate to severe enlarged tonsils,hepatomegaly and complications （especially cough and gastrointestinal symptoms）were more common in the EBV ＋MP group than the EBV group with significant differences （remarkable tonsillitis：88.89 vs 48.84%,hepatomegaly：55.56 vs 13.95%,complications：72.22 vs 44.19%;χ2 =8.529,10.719 and 3.999 respectively;P =0.003,0.001 and 0.046 respectively）.The WBC and lymphocyte counts,percentage of abnormal lymphocyte and the levels of glutamyltranspeptidase in the EBV ＋MP group were also significantly higher than the EBV group [WBC counts：（18.17 ±7.17）×109 /L vs （13.70 ±7.12）×109 /L], lymphocyte counts：（11.61 ±6.04）×109 /L vs （7.65 ±4.82）×109 /L,abnormal lymphocyte proportion：（20.69 ± 13.03）% vs （13.00 ±11.20）%,serum glutamyltranspeptidase：（99.41 ±91.20）U /L vs （47.95 ±69.22）U /L;t =2.231,2.716,2.215 and 2.239 respectively;P =0.029,0.009,0.031 and 0.029 respectively）.But the average hospital stay and the recovery time of manifestations showed no significant differences in the two groups （P 〉0.05）. Conclusion IMchildren with EBV and MP infection have more cases with moderate to severe enlarged tonsils,hepa-tomegaly and complications,moreover present higher lymphocyte and similar outcomes.MP should be tested in all IM children.The early diagnosis and treatment are the keys to improve the prognosis of IM children with EBV and MP infection.