不同年龄段儿童传染性单核细胞增多症临床特点及合并肝功能异常危险因素分析

Analysis of Clinical Characteristics and Risk Factors of Abnormal Liver Function in Infectious Mononucleosis Children at Different Ages

【目的】总结不同年龄段儿童传染性单核细胞增多症(IM)的临床特点并探讨其发生肝功能异常的危险因素。【方法】回顾性分析2017年8月1日至2020年8月1日在广州中医药大学第一附属医院儿科住院部确诊为IM的85例患儿,回顾其临床资料,总结其中医证候特点及不同年龄段儿童IM发病特点,并运用多因素Logistics回归分析合并肝功能异常的危险因素。【结果】(1)85例IM患儿中以男性为主,发病年龄以学龄前为主,发病节气以霜降、寒露、处暑最多见。(2)临床表现方面:以发热、咽峡炎、颈部淋巴结肿大的三联征为主要临床表现,分别占94.1%(80/85)、98.8%(84/85)和100.0%(85/85),且大多数IM患儿伴有鼻塞表现,但皮疹少发;其中脾肿大及皮疹在不同年龄组间差异有统计学意义(P<0.05)。(3)中医证型分布方面,以热毒壅滞证最常见,占69.4%(59/85),其他从高到低依次为热毒炽盛证、热邪犯肺证和正虚邪恋证,分别为17.6%(15/85)、10.6%(9/85)和2.4%(2/85)。(4)有近半数的IM患儿合并有肝功能异常,在常见的危险因素中,发病年龄及节气与IM合并肝功能异常关系较密切(P<0.05或P<0.01),即患儿的年龄越大[OR=2.839,95%CI(1.406,5.731)]、发病节气越往后[OR=1.118,95%CI(1.003,1.247)],其发生肝功能异常的可能性越大。【结论】IM患儿的中医证型主要为热毒壅滞证;发病年龄及节气是IM合并肝功能异常的危险因素。

Objective To investigate the clinical characteristics of infectious mononucleosis(IM)in children at different ages and to explore the risk factors of the complication of abnormal liver function. Methods The clinical data of 85 cases of IM children admitted in the pediatric inpatient department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from August 1, 2017 to August 1, 2020 were retrospectively analyzed. The traditional Chinese medicine syndrome manifestations in IM children at different ages were investigated and the risk factors of the complication of abnormal liver function in the IM children were analyzed by multiple Logistic regression analysis. Results(1)Of the 85 cases of IM children,the male was predominated,and the onset age was at preschool age. The onset of IM was mostly seen in the solar terms of Frost’s Descent,Cold Dew, and the Limit of Heat.(2)The clinical manifestations of IM in children were characterized by the triad syndrome of fever,angina and cervical lymphadenectasis,which accounted for 94.1%(80/85),98.8%(84/85),and 100.0%(85/85)respectively. Most of IM children had the accompanied symptom of nasal obstruction,but skin rash was less found. The difference of the incidence of splenomegaly and skin rash among various age groups was statistically different(P<0.05).(3)In respect of the traditional Chinese medicine(TCM)syndrome types of IM in children,the syndrome of heat-toxin accumulation was mostly common,which accounted for 69.4%(59/85).And then came the syndromes of abundance of heat toxin,heat attacking the lung,deficiency of healthy qi with lingering pathogenic qi, which accounted for 17.6%(15/85), 10.6%(9/85), and 2.4%(2/85)respectively.(4)Almost half of the cases were complicated with abnormal liver function. And the common risk factors of onset age and solar terms were closely related with the onset of IM complicated with abnormal liver function(P<0.05 or P<0.01),indicating that the IM children with older age[OR = 2.839,95%CI(1.406,5.731)] and the later onset solar terms[OR = 1.118, 95% CI(1.003, 1.247)] had the greater possibility of suffering from abnormal liver function. Conclusion IM children is characterized by the TCM syndrome of heat-toxin accumulation,and onset age and solar terms are the risk factors of IM complicated with abnormal liver function.