腺苷脱氨酶及外周血异型淋巴细胞联合测定对小儿传染性单核细胞增多症的诊断价值

Diagnostic Value of Combined Detection of Serum Adenosine Deaminase and Abnormal Peripheral Lymphocytes in Children Infectious Mononucleosis

目的探讨血清腺苷脱氨酶(adenosine deaminase,ADA)及外周血异型淋巴细胞联合检测在传染性单核细胞增多症(IM)患儿诊断及鉴别诊断中的临床价值。方法采用过氧化物酶法检测50例IM患儿血清ADA活性水平及外周血涂片分类100个白细胞,计数异型淋巴细胞百分比,并与50例同时期健康体检(排除EB病毒感染)对照组儿童进行比较。结果血清ADA检测对小儿IM鉴别诊断特异性为71.0%、敏感性为55.6%、准确性为69.8%;外周血异型淋巴细胞分类计数特异性为61.1%、敏感性为58.6%、准确性为63.3%;联合两项指标检测特异性为76.9%、敏感性为67.8%、准确性为79.8%。结论联合检测血清ADA及外周血异型淋巴细胞有助于小儿IM的诊断,较单一指标检测可明显提高诊断特异性、敏感性及准确性。患儿出现不规则发热,且血清ADA水平及异型淋巴细胞比例升高时,应考虑到有EB病毒感染的可能性。

Objective To study the clinical value of diagnosis and differential diagnosis of combined detection serum adenosine deaminase（ADA）and abnormal peripheral lymphocytes in children infectious mononucleosis（IM）. Methods The serum adenosine deaminase activity level was detected in 50 cases of infectious mononuclear cells increased patients by peroxidase and 100 white blood cells of outside blood were classified with smears,and the percentage of abnormal lymphocytes was worked out. And then a comparison was made with 50 cases of healthy physical examination（excluding EB infection）children in the control group. Results The specificity,sensitivity and accuracy of differential diagnosis of serum adenosine deaminase in children with infectious mononucleosis were 71.0 %, 55.6%, and 69.8, respectively. The specificity, sensitivity and accuracy of peripheral blood lymphocyte classification were 72.1%,58.6 %, and 70.3%, respectively. The specificity, sensitivity and accuracy of the combined indicators were 76.9%, 67.8%, and 79.8%,respectively. Conclusion The combined detection of serum ADA and peripheral blood lymphocytes is more helpful for the diagnostic of infectious mononucleosis in children. Compared with the single index detection, the diagnosis specificity, sensitivity and accuracy can be improved significantly. So when there is irregular fever in children with the increased serum ADA level and the proportion of abnormal lymphocytes,the possibility of EB infection should be considered.