合并肺炎支原体感染的儿童EB病毒传染性单核细胞增多症的临床特点及高危因素分析

Clinical characteristics and risk factors of Epstein Barr virus infectious mononucleosis complicated with Mycoplasma pneumoniae infection in children

目的分析EB病毒传染性单核细胞增多症(EBV-IM)合并肺炎支原体(MP)感染患儿的临床特点及高危因素,为临床及时准确的治疗提供依据。方法回顾性收集2018年1月1日至2019年12月31日在首都医科大学附属北京友谊医院儿科因EBV-IM住院患儿的临床及实验室检查资料,按是否存在MP感染,分为单纯EB病毒感染组(IM组)62例及合并MP感染组(MP-IM组)36例。比较2组患儿的一般资料(性别、年龄、发病季节)、临床表现(热峰、热程)以及实验室检查结果。结果MP-IM组的患儿平均年龄大于IM组的患儿,其中学龄期儿童占比明显高于IM组,差异有统计学意义(P<0.05)。MP-IM组的患儿热程明显长于IM组,差异有统计学意义(P<0.05)。2组患儿在实验室检查方面:MP-IM组的患儿中性粒与淋巴细胞比值(NLR)、C反应蛋白、IgG、IgM水平明显高于IM组患儿,差异有统计学意义(P<0.05)。年龄和热程是合并MP感染的独立危险因素,年龄大于6.085岁、热程大于9.5 d具有较高的诊断价值。结论在EBV-IM儿童的诊治过程中,合并MP感染的患儿病情及炎症反应相对较重,体液免疫紊乱更为明显。对于发热时间长、学龄期的儿童需进行MP的检测,及早进行抗感染治疗。

Objective To explore the clinical features and high-risk factors of children with Epstein-Barr virus infectious mononucleosis(EBV-IM)combined with Mycoplasma pneumoniae infection,so as to provide a basis for timely and accurate clinical treatment.Methods The clinical and laboratory data of hospitalized children with EBV-IM in the Department of Pediatrics of Beijing Friendship Hospital,Capital Medical University from January 1,2018 to December 31,2019 were collected retrospectively.According to the presence or absence of mycoplasma pneumoniae infection,the patients were divided into two groups:simple EB virus infection group(IM group)62 cases and mycoplasma pneumoniae infection group(MP-IM group)36 cases.The general information(sex,age,season of onset),clinical manifestations(heat peak,heat course)and laboratory test results of the two groups of children were compared.Results The average age of children in MP-IM group was older than that in children with IM group,and the proportion of school-age children in MP-IM group was significantly higher than that in IM group(P<0.05).The fever course in MP-IM group was significantly longer than that in IM group(P<0.05).In terms of laboratory examination,the levels of neutrophil/lymphocyte ratio(NLR),CRP,IgG and IgM in MP-IM group were significantly higher than those in IM group.Age and fever course were independent risk factors for complicating mycoplasma pneumoniae infection.It was of high diagnostic value that the age was more than 6.085 years old and the heat course was more than 9.5 days.Conclusion In the process of diagnosis and treatment of EBV infectious mononucleosis children,children with Mycoplasma pneumoniae infection are relatively serious.For children with long fever and school age,Mycoplasma pneumoniae should be detected and anti-infection treatment should be carried out as soon as possible.