36例成人传染性单核细胞增多症疾病特点分析

Features of 36 cases with infectious mononucleosis in adult

目的通过对成人传染性单核细胞增多症患者的临床表现、实验室特征、治疗及转归等总结疾病特点,进一步指导临床诊疗。方法对内蒙古医科大学附属医院2014年2月—2017年2月诊治住院的36例患者详尽资料进行回顾性分析。结果本组36例患者以青年为主,平均年龄在31岁,主要症状包括发热36例(100.0%)、乏力25例(69.4%)、咽痛19例(52.8%);主要体征为浅表淋巴结肿大32例(88.9%)、脾大24例(66.7%)、皮疹16例(44.4%)、扁桃体肿大14例(38.9%)、肝肿大12例(33.3%)。实验室检查结果为外周血白细胞>10×10~9/L 33例(91.7%),淋巴细胞比例高于正常34例(94.4%),外周血异型淋巴细胞>10%36例(100.0%);肝功能异常者28例(77.8%);EB病毒检测抗核衣壳抗原IgM阳性32例(88.9%)、抗核衣壳抗原IgG阳性34例(94.4%)、EBV-DNA阳性30例(83.3%)。治疗以抗病毒、肾上腺糖皮质激素及对症支持为主。结论成人传染性单核细胞增多症患者多见于青年人群,临床表现多种多样,发热持续时间长,疾病早期容易误诊,在发病早期检测抗核衣壳抗原IgM阳性、抗核衣壳抗原IgG阳性、EBV-DNA及淋巴细胞、外周血异型淋巴细胞对早期诊断具有重要价值。

Objective To investigate the clinical manifestation and laboratory examination results and cured and prognosis of infectious mononucieosis（IM）and to guide clinical therapy. Methods The clinical data of 36 adult patients with IM, who were hospitalized in Affiliated Hospital of Inner Mongolia Medical University, from Feb. 2014 to Feb. 2017, were analyzed retrospectively. Results Our group of 36 adult patients with IM mainly affected young people.The average age of the patients was 31 years old. Most common clinical symptoms included fever 36 cases （100.0%）,hypodynamia 25 cases （69.4%） and pharyngodynia 19 cases （52.8%）;The major signs included superficial lymph node enlargement 32 cases （88.9%）, splenomegaly 24 cases （66.7%）, skin rash 16 cases （44.4%）, antiadoncns 14 cases （38.9%）, hepatomegaly 12 cases （33.3%）. Besides, laboratory examination results showed that 33 cases（91.7% ） IM patients had white blood cell count more than 10× 109/L,; 34 cases（94.4%） had increased lymphocyte ratio beyond normal; 36 cases（100.0%） had atypical lymphocyte ratio more than 10% ;28 cases（77.8%） had liver function damages. 32 cases（88.9%） had positive Epstein-Barr virus （EBV） IgM. 34 cases（94.4%） had positive Epstein-Barr virus （EBV） IgG. 30 cases （83.3%） EBV-DNA had positive. Anti-virus, glucocorticoid, complaint management and maintenance therapy were the main methods. Conclusions The incidence of IM is higher in the young people. And the patients had various clinical manifestations, with longer fever period, and high rate of early misdiagnosis. Chances of misdiagnosis and missed diagnosis could be decreased via better understanding of the diverse laboratory examination in adult patients with IM.