传染性单核细胞增多症合并多种病原体感染患儿临床特征和预后研究

Clinical features and prognosis of children with infectious mononucleosis complicated by multiple pathogen infections

目的:研究传染性单核细胞增多症(IM)合并多种病原体感染患儿的临床特征和预后。方法:纳入IM患儿60例,根据病原体感染情况分为单纯EBV感染组和多重感染组,各30例。分析多重感染组病原体分布特征,比较两组的临床特征、实验室指标、并发症发生率、治疗方法以及预后。结果:IM患儿合并感染病原体主要为肺炎支原体(MP)(33.33%)和巨细胞病毒(CMV)(23.33%)。多重感染组发热、脾脏肿大、肝肿大、淋巴结肿大、咽峡炎、眼睑水肿的发生率明显高于单纯EBV感染组(P<0.05),多重感染组的发热持续时间明显高于单纯EBV感染组(P<0.05)。多重感染组白细胞计数(WBC)、异型淋巴细胞(AL)比例、磷酸肌酶同工酶(CK-MB)、丙氨酸氨基转移酶(ALT)和CD3水平均明显高于单纯EBV感染组(P<0.05)。多重感染组肺炎、贫血、心肌损害、肝损伤和消化道出血的发生率均明显高于单纯EBV感染组(P<0.05)。两组患儿出院时体温均恢复正常,临床体征均得以明显缓解,心肌功能和肝功能均于治疗2~4周后恢复正常,预后良好。结论:IM患儿的病原体分布特征具有多样性,并以EBV与MP、CMV的多重感染为主。与单纯EBV感染患儿相比,IM多重感染患儿病情更为严重,并发症发生率更高。

Objective:To study the clinical characteristics and prognosis of children with infectious mononucleosis(IM) complicated by multiple pathogen infections.Methods:Sixty children with IM were included and divided into simple EBV infection group and multiple infection group according to pathogen infection,with 30 cases in each group.The distribution characteristics of pathogens in the multiple infection group were analyzed.The clinical characteristics,laboratory indicators,incidence of complications,treatment methods and prognosis of the two groups were compared.Results:The main co-infected pathogens in children with IM were Mycoplasma pneumonia(MP)(33.33%) and Cytomegalovirus(CMV)(23.33%).The incidence of fever,splenomegaly,hepatomegaly,lymphadenopathy,angina and eyelid edema in the multiple infection group was significantly higher than that of simple EBV infection group(P<0.05),and the duration of fever was significantly lower than that of simple EBV infection group(P<0.05).The WBC,AL ratio,CK-MB,ALT and CD3+ levels in the multiple infection group were significantly higher than those in the simple EBV infection group(P<0.05).The incidence of pneumonia,anemia,myocardial damage,liver damage and gastrointestinal bleeding in the multiple infection group was significantly higher than that in the simple EBV infection group(P<0.05).When the two groups of children were discharged from the hospital,their body temperature returned to normal,and their clinical signs were significantly relieved.Myocardial and liver functions returned to normal after 2-4 weeks of treatment,and the prognosis was good.Conclusion:The distribution characteristics of pathogens in children with IM are diverse,and the multiple infections of EBV,MP and CMV are the main ones.Compared with children with simple EBV infection,the condition of IM children with multiple infections are more severe and have a higher incidence of complications.