外周血细胞形态学检查在小儿传染性单核细胞增多症早期诊断中的应用及临床意义分析

The role of peripheral blood cells morphology in early diagnosis of infectious mononucleosis in children and its clinical significance

目的探究小儿传染性单核细胞增多症(IM)早期诊断中外周血细胞形态学检查的应用及临床意义。方法选取2018年4月至2020年5月我院收治的小儿IM患者100例,全部患者均进行外周血细胞形态学检查。观察临床诊断中的诊断情况、不同年龄患儿的血常规情况以及不同时间段异型淋巴细胞情况、异型淋巴细胞的形态种类。结果与最终诊断结果相比较,外周血细胞形态学检查中,误诊32例(32%),准确率为68.0%(68例);<3岁患儿的白细胞计数、淋巴细胞明显高于3~6岁、>6岁患儿(P<0.05);<3岁患儿的异型淋巴细胞数量明显低于3~6岁、>6岁患儿(P<0.05),且3~6岁患儿的异型淋巴细胞数量低于>6岁患儿(P<0.05);同时<3岁患儿的血小板计数与3~6岁、>6岁患儿差异无统计学意义(P>0.05);初检后1周实施复检的异型淋巴细胞检查阳性率明显高于初检(P<0.05);初检、复检时异型淋巴细胞阳性中泡沫样异型淋巴细胞、单核样异型淋巴细胞的数量均多于幼稚型异常淋巴细胞数量(P<0.05)。结论利用外周血细胞形态学检查对小儿IM进行早期检测,能够提高临床诊断的准确率,同时清楚认识到IM发作时机体内白细胞、血小板以及淋巴细胞等血常规指标因不同年龄和不同检查时间段而存在差异,为随后的诊断和治疗提供了比较重要的依据,提高了临床治疗和预后效果,值得推广应用。

Objective To investigate the role of peripheral blood cells morphology in early diagnosis of infectious mononucleosis(IM)in children and its clinical significance.Methods A total of 100 children with IM admitted to our hospital between April 2018 and May 2020 were included in the study.All patients underwent morphological study of peripheral blood cells.The clinical diagnosis,blood routine test,atypical lymphocytes at different time periods,and the morphological types of atypical lymphocytes in children at different ages were determined.Results Compared with the results of final diagnosis,32 cases(32.0%)were misdiagnosed in the morphological examination of peripheral blood cells,and the accuracy rate was 68.0%.The white blood cell count and the lymphocyte count in children aged<3 years old were significantly higher than those in children aged 3-6 years old and>6 years old(both P<0.05).The heterotypic lymphocyte count in children aged<3 years old was significantly lower than that in children aged 3-6 years old and>6 years old(P<0.05),and the heterotypic lymphocyte count in children aged 3-6 years old was lower than that in children aged>6 years old(P<0.05).Meanwhile,there was no significant difference in platelet count among children aged<3 years old,3-6 years old and those aged>6 years old(P>0.05).The positive rate of atypical lymphocytes in the re-examination performed at one week after the initial examination was significantly higher than that in the initial examination(P<0.05).The number of foam-like atypical lymphocytes and monocyte-like atypical lymphocytes in the initial examination and re-examination of atypical lymphocytes were more than that of infantile abnormal lymphocytes(P<0.05).Conclusion Early detection of infectious mononucleosis in children with morphological examination of peripheral blood cells may improve the accuracy of clinical diagnosis.At the same time,it is clearly recognized that the blood routine indicators such as white blood cells,platelets and lymphocytes in the host at the time of IM onset vary with ages and time frame of examination.It provides a significant basis for subsequent diagnosis and treatment,and improves the effects of clinical treatment and prognosis,and thereby is worthwhile of widespread use.