摘要
目的 探讨儿童传染性单核细胞增多症(infectious mononucleosis,IM)的临床特征、诊断及治疗方法。方法 选取 2018年1月至2020年2月上海市东方医院儿科住院部IM患儿36例为研究对象,回顾性分析其临床表现、实验室检查及治疗等。结果 纳入的IM患儿主要临床表现有淋巴结炎(97.22%)、发热(86.11%)、咽扁桃体炎(77.78%)、肝大(33.33%)、脾大(47.22%)、眼睑水肿(33.33%)及皮疹(8.33%)。不同年龄患儿脾大发生率差异有统计学意义(P <0.05),学龄期、青春期患儿较幼儿期更易发生脾大。白细胞升高(61.11%),异型淋巴细胞≥10%(94.44%)。33例患儿EB病毒(Epstein-Barr virus,EBV)抗体,EBV-病毒衣壳抗原(viral capsid antigen,VCA)-免疫球蛋白(immunoglobulin,Ig)M抗体、EBV-VCAIgG抗体、EBV-VCA-IgA抗体、EBV-早期抗原(early antigen,EA)-IgA抗体、EBV-EA-IgG抗体、EBV-核抗原-IgG抗体阳性率分别为87.88%、57.58%、33.33%、27.27%、18.18%、0。合并其他病原感染包括14例支原体阳性,流感病毒及鼻病毒阳性各1例。并发症为粒细胞减少(61.11%)、肝功能损害(52.78%)、贫血(47.22%)、心肌损害(44.44%)、呼吸道感染(41.67%)。88.89%患儿接受了更昔洛韦抗病毒治疗,全部患儿接受了对症支持治疗,预后良好。结论 IM多见于3~6岁学龄前儿童,不同年龄儿童临床特征存在差异。EBV抗体检测有助于确诊,EBV-DNA检测可用于诊断及评估病情,值得推广。临床治疗可以更昔洛韦抗病毒及对症治疗为主,疗效及预后良好。
Objective To investigate the clinical features,diagnosis and treatment of infectious mononucleosis(IM) in children.Methods From January 2018 to February 2020,36 children with IM in the department of pediatrics of Shanghai oriental hospital were selected as the research objects,and their clinical manifestations,laboratory tests and treatment were retrospectively analyzed.Results There were 36 cases of IM children,the main clinical manifestations were lymphadenitis(97.22%),fever(86.11%),pharyngeal tonsillitis(77.78%),hepatomegaly(33.33%),splenomegaly(47.22%),eyelid edema(33.33%) and rash(8.33%).There were significant differences in the incidence of splenomegaly among children of different ages(P<0.05),and children of school age and adolescence were more likely to have splenomegaly than children.Leukocytes increased(61.11%),and heterotypic lymphocytes≥10%(94.44%).Epstein-Barr virus(EBV) antibodies,induding EBV-viral capsid antigen(VCA)-immunoglobulin(Ig)M antibody,EBV-VCA-IgG antibody,EBV-VCA-IgA antibody,EBV-early antigen(EA)-IgA antibody,EBV-EA-IgG antibody and EBV-nuclear antigen-IgG antibody,were detected in 33 children.The positive rates of them were 87.88%,57.58%,33.33%,27.27%,18.18% and 0,respectively.14 cases were mycoplasma positive,1 case was influenza virus positive and 1 case was rhinovirus positive.The complications were granulocytopenia(61.11%),liver function damage(52.78%),anemia(47.22%),myocardial damage(44.44%) and respiratory tract infection(41.67%).88.89% of the children received antiviral therapy with ganciclovir,and all of them received symptomatic and supportive treatment,with good prognosis.Conclusion IM is more common in preschool children aged 3-6 years.There are differences in clinical characteristics among children of different ages.EBV antibody detection is helpful for diagnosis,and EBV-DNA detection can be used for diagnosis and evaluation of the disease,which is worthy of promotion.Clinical treatment with ganciclovir antiviral and symptomatic treatment,the curative effect and prognosis are good.
作者
孙敏
刘芳
SUN Min;LIU Fang(Department of Pediatrics,Shanghai Oriental Hospital,Shanghai 200120,China)
出处
《世界临床药物》
CAS
2022年第8期1033-1038,共6页
World Clinical Drug
基金
上海市科学技术委员会课题(18DZ1910606)。
