儿童传染性单核细胞增多症临床及实验室检查特点分析

Analysis of clinical and laboratory characteristics of infectious mononucleosis in children

目的分析儿童传染性单核细胞增多症(IM)的临床特点、实验室检查指标等,以提高临床医生对此病的认识。方法采用回顾性分析方法,收集2019年5月—2020年4月中国科学技术大学附属第一医院儿科住院的114例传染性单核细胞增多症患儿的临床资料,总结并分析其临床特点。结果114例患儿中男66例、女48例,男女之比为1.375∶1;年龄≤3岁39例、3~6岁60例、>6岁15例;季节分布为春季34例、夏季27例、秋季36例、冬季17例;症状表现为发热107例、咽峡炎107例、颈部淋巴结肿大93例、肝脏肿大41例、脾脏肿大65例、眼睑浮肿56例、皮疹23例;实验室检查特点:白细胞总数在(10~20)×10^(9)/L居多;淋巴细胞比例在50%~70%居多;异型淋巴细胞阳性率为68.42%;肝功能损害59例;衣壳抗原IgM抗体阳性率最高;全血EB病毒核酸(EBV-DNA)检测阳性率为92.86%。结论儿童IM多发于男性且以3~6岁常见,春秋季节发病率高,临床症状表现多样,衣壳抗原IgM抗体检测联合全血EBV-DNA检测可提高检测阳性率,减少临床漏诊及误诊。

Objective To analyse the clinical characteristics and laboratory examination indicators of children with infectious mononucleosis(IM)and improve the understanding of clinicians.Methods The clinical data of 114 children with IM hospitalised in the First Affiliated Hospital of the University of Science and Technology of China from May 2019 to April 2020 were retrospectively analysed to summarise and analyse their clinical characteristics.Results The 114 patients included 66 males and 48 females.The male-to-female ratio was 1.375∶1.The age distribution was as follows:<3 years old,39 cases;3-6 years old,60 cases;>6 years old,15 cases.The seasonal distribution was as follows:34 cases in spring,27 cases in summer,36 cases in autumn and 17 cases in winter.The clinical manifestation was as follows:107 cases of fever,107 cases of pharyngitis,93 cases of cervical lymph node enlargement,41 cases of liver enlargement,65 cases of spleen enlargement,56 cases of eyelid oedema and 23 cases of rash.The total number of peripheral leukocytes ranged between 10×10^(9)/L and 20×10^(9)/L.The characteristics of laboratory tests were as follows:the lymphocyte ratio ranged between 50%and 70%,the prevalence of atypical lymphocytes in peripheral blood was 68.42%,a total of 59 cases had liver function impairment.The positive rate of capsid antigen IgM antibody was the highest.The positive rate of Epstein-Barr virus nucleic acid(EBV-DNA)in whole blood was 92.86%.Conclusion IM in children is more common in males and ages 3 to 6 years.The incidence rate is high in spring and autumn.The clinical symptoms include pneumonia and myocardial damage.Most of them have good prognosis.Capsid antigen IgM antibody detection combined with whole blood EBV-DNA detection can improve the positive detection rate and reduce clinical missed diagnosis and misdiagnosis.