传染性单核细胞增多症伴肝功能损伤患儿的临床特征及影响因素分析

Clinical analysis of children with infectious mononucleosis with liver function injury

目的:分析传染性单核细胞增多症(IM)患儿的临床资料,分析其伴肝功能损伤的临床特征及相关因素。方法:收集2020年1月—2023年8月于修文县人民医院儿科住院治疗的IM患儿68例,按谷丙转氨酶(ALT)>50 U/L和/或谷草转氨酶(AST)>40 U/L,肺炎支原体(MP)血清抗体≥1:160为阳性,采用二元Logistic分析进行其独立风险因素分析。结果:68名患儿,男34例(50%),女34例(50%),发病年龄(5.1±2.7)岁,IM患儿各年龄组ALT值比较:<3岁23例(33.8%)患儿ALT水平47.9(258.0,67.6)U/L,3~<6岁23例(33.8%)患儿的ALT水平为53(21.9,149.0)U/L,6~7岁22例(32.4%)患儿ALT水平为81.25(54.9,206.0)U/L,各年龄组间ALT值存在统计学差异(K=7.92,P=0.019),亦可见随着年龄的增长,ALT值呈上升趋势。肝功能损伤组48例(70.6%),无肝功能损伤组20例(29.4%),比较两组间一般资料,患儿性别、年龄、MP感染、住院时间、住院费用存在统计学差异(P<0.05)。肝损伤组GGT与ALT的相关性(r=0.671,P=0.01),与AST的相关性(r=0.573,P=0.01),从数据分析可得出GGT值与ALT、AST呈正相关关系。肝损伤组DNA高低载量组间ALT、AST、LDH比较,均无统计学意义(P>0.05)。肝损伤与无肝损伤组间女性比率、年龄、住院天数、住院费用差异均存在统计学意义。对上述影响因素做二元Logistic行风险因素分析,可得出患儿年龄(OR=1.617,95%CI:1.067~2.449,P=0.023)为独立影响肝功能的因素。结论:传染性单核细胞增多患儿年龄越大,肝功能损伤发生率越高,损伤程度越重;EBV-DNA病毒载量与肝功能损伤程度无统计学相关性,肝功能损伤消耗的医疗资源更大,需要及时诊断及时治疗。

Objective To analyze the clinical data of infectious mononucleosis and the clinical features and related factors of hepatic injury.Methods A total of 68 children with IM who were hospitalized in the Department of Pediatrics of Xiuwen County People's Hospital from January 2020 to August 2023,was defined as ALT>50 U/L and/or AST>40 U/L,serum anti-mycoplasma pneumoniae(MP)antibody titer 1:160.Spearman rank correlation was used for correlation analysis.Multiple single factors were statistically different between the liver injury group and the non-hepatic injury group,and independent risk factor analysis was performed using binary logistic.Results 68 patients were collected,34 males(50%),34 females(50%),the age of onset(5.1±2.7)years.The ALT was 47.9(258.0,67.6)U/L in 23 cases(33.8%)aged<3 years old,53(21.9,149.0)U/L in 23 cases(33.8%)aged 4 to<6 years old,and 81.25(54.9,206.0)U/L in 22 cases aged 6 to 7 years old.There was statistical difference in ALT among all age groups(K=7.92,P=0.019),and the ALT increased with the age.There were 48 cases(70.6%)in liver function injury group and 20 cases(29.4%)in no liver function injury group.There were statistical differences in sex,age,MP infection,hospitalization time and hospitalization cost(P<0.05).The correlation between GGT and ALT(r=0.671,P=0.01),and AST(r=0.573,P=0.01)in the liver injury group.The data analysis showed that the increase of GGT was positively correlated with ALT and AST.There was no significant difference in ALT,AST and LDH between the high and low DNA loading groups(P>0.05).There were statistical significances in the proportion of females,age,length of hospital stay and hospital expenses between liver injury and non-hepatic injury groups.The risk factor analysis of the above influencing factors by binary logistic analysis showed that the age(OR=1.617,95%CI:1.067~2.449.P-0.023)of children was an independent factor affecting liver function.Conclusions The higher the age of children with infectious mononucleosis,the higher the incidence of liver function injury and the higher the degree of injury.EBV-DNA viral load is not related to the degree of liver function injury.Liver function injury consumes more medical resources and needs timely diagnosis and treatment.