小儿传染性单核细胞增多症15例临床分析
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摘要
目的:分析小儿传染性单核细胞增多症(IM)的临床特征、治疗方法和疗效,进一步加强对本病的认识。方法:回顾性分析2017年1月—2017年12月15例IM住院患儿的相关临床资料。结果:IM住院患儿共15例,其中男10例,女5例,年龄从10个月19 d至12岁11个月。以幼儿期和学龄前期为主,各为33. 3%。主要临床表现有咽峡炎(100. 0%)、淋巴结炎(93. 3%)、发热(80. 0%)、扁桃体渗出(46. 7%)、肝大(46. 7%)、脾大(40. 0%)、眼睑水肿及皮疹(各为26. 7%)。80%的患儿出现白细胞及异型淋巴细胞增高。检测EB病毒(EBV)抗体,EB病毒衣壳抗原Ig M抗体(EBV-CAIgM)、EB病毒衣壳抗原Ig G抗体(EBV-CAIgG)、EB病毒早期抗原Ig G抗体(EBV-EAIgG)、EB病毒核抗原Ig G抗体(EBV-NAIgG),阳性率分别为73. 3%、46. 7%、6. 7%、33. 3%。其中6例衣原体抗体阳性,2例同时合并嗜肺军团菌抗体阳性,其他还包括腺病毒、支原体、流感病毒等阳性。并发症为呼吸道感染(60. 0%)、肝功能损害(53. 3%)、心肌损害(26. 7%)、贫血及粒细胞减少(各为20. 0%)、胆汁淤积(13. 3%),另外少数出现面神经麻痹、心包积液、中耳炎、血尿(各为6. 7%)。治疗主要包括抗病毒及对症支持治疗,多数预后良好。结论:IM患儿幼儿期和学龄前期多见。主要临床表现为发热、咽峡炎、淋巴结炎、扁桃体渗出、肝脾肿大、眼睑水肿及皮疹。EBV抗体检测对于判断EBV感染具有价值。IM患儿并发症以呼吸道感染最为常见。另外易合并肝功能、心肌损害,还可伴有中性粒细胞减少、血小板减少及贫血。临床治疗主要以阿昔洛韦、更昔洛韦抗病毒及其他对症治疗为主,效果及预后良好。
Objective: To explore the clinical features,treatment methods and therapeutic effects of infectious mononucleosis( IM) in children,and further strengthen the understanding of this disease. Methods: We reviewed data of 15 cases of IM hospitalized children from January 2017 to December. Results: The clinical manifestations of IM are diverse. Data from 15 hospitalized patients( 10 males and 5 females),ranged in age from 10 months and 19 days to 12 years and 11 months. The children of toddler age and preschool-age were main groups of IM,accounted for 33. 3% respectively. The Pharyngitis( 100. 0%),lymphadenitis( 93. 3%),fever( 80. 0%),tonsillitis and hepatomegaly( 46. 7% each),splenomegaly( 40. 0%),blepharoedema and rash( 2 6. 7 %) ere the most important clinical manifestations of IM. Leukocytes and atypical lymphocytes increased in80. 0% of the children. The seropervalence of EB virus capsid protein Ig Mantibody( EBV-CAIg M),EB virus capsid protein Ig G antibody( EBV-CAIg G),EB virus early antigen Ig G antibody( EBV-EAIg G),EB virus nuclear antigen Ig G antibody( EBV-NAIg G) were 73. 3%,46. 7%,6. 7%,33. 3% respectively. Among them,6 cases were positive for Chlamydia antibody and 2 cases were also positive for Legionella pneumophila antibody. Others include a few mycoplasma,adenovirus,influenza virus and other positive. The complications were respiratory tract infection( 60. 0%),liver damage( 53. 3%),myocardial damage( 26. 7%),anemia and granulocytic( 20. 0% each),cholestasis( 13. 3%). In addition,a small number of facial paralysis,pericardial effusion,otitis media,hematuria( 6. 7% each). All of the patients were treated with supportive therapy and antiviral medication. Most of the patients were benign and self limited. Conclusion: The age of onset is early childhood and early school age. The main clinical manifestations of IM children were fever,pharyngitis,lymphadenitis,tonsillar exudation,hepatosplenomegaly,blepharoedema and dermatitis. EBV antibody detection is valuable for determining EBV infection. Complications of IM children are most common with respiratory infections. In addition,it is easy to combine liver function and myocardial damage,and may also be accompanied by neutropenia,thrombocytopenia and anemia. Acyclovir,ganciclovir and other symptomatic treatments are the main clinical treatments. Most of the patients were benign and self limited. The prognosis was favorable.
Objective: To explore the clinical features,treatment methods and therapeutic effects of infectious mononucleosis( IM) in children,and further strengthen the understanding of this disease. Methods: We reviewed data of 15 cases of IM hospitalized children from January 2017 to December. Results: The clinical manifestations of IM are diverse. Data from 15 hospitalized patients( 10 males and 5 females),ranged in age from 10 months and 19 days to 12 years and 11 months. The children of toddler age and preschool-age were main groups of IM,accounted for 33. 3% respectively. The Pharyngitis( 100. 0%),lymphadenitis( 93. 3%),fever( 80. 0%),tonsillitis and hepatomegaly( 46. 7% each),splenomegaly( 40. 0%),blepharoedema and rash( 2 6. 7 %) ere the most important clinical manifestations of IM. Leukocytes and atypical lymphocytes increased in80. 0% of the children. The seropervalence of EB virus capsid protein Ig Mantibody( EBV-CAIg M),EB virus capsid protein Ig G antibody( EBV-CAIg G),EB virus early antigen Ig G antibody( EBV-EAIg G),EB virus nuclear antigen Ig G antibody( EBV-NAIg G) were 73. 3%,46. 7%,6. 7%,33. 3% respectively. Among them,6 cases were positive for Chlamydia antibody and 2 cases were also positive for Legionella pneumophila antibody. Others include a few mycoplasma,adenovirus,influenza virus and other positive. The complications were respiratory tract infection( 60. 0%),liver damage( 53. 3%),myocardial damage( 26. 7%),anemia and granulocytic( 20. 0% each),cholestasis( 13. 3%). In addition,a small number of facial paralysis,pericardial effusion,otitis media,hematuria( 6. 7% each). All of the patients were treated with supportive therapy and antiviral medication. Most of the patients were benign and self limited. Conclusion: The age of onset is early childhood and early school age. The main clinical manifestations of IM children were fever,pharyngitis,lymphadenitis,tonsillar exudation,hepatosplenomegaly,blepharoedema and dermatitis. EBV antibody detection is valuable for determining EBV infection. Complications of IM children are most common with respiratory infections. In addition,it is easy to combine liver function and myocardial damage,and may also be accompanied by neutropenia,thrombocytopenia and anemia. Acyclovir,ganciclovir and other symptomatic treatments are the main clinical treatments. Most of the patients were benign and self limited. The prognosis was favorable.
引文
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[2]杨艳秋.EB病毒感染与传染性单核细胞增多症的相关性分析[J].临床输血与检验,2013,15(2):167.
[3]王小鹏,焦44,陈凌,等.不同年龄儿童传染性单核细胞增多症临床特点分析[J].教育生物学杂志,2017,5(1):37-41.
[4]谢明红.小儿传染性单核细胞增多症40例临床分析[J].临床检验杂志,2017,6(2):400.
[5]孙雨,王华,胡青华,等.不同年龄儿童传染性单核细胞增多症临床特征分析[J].临床误诊误治,2013,26(11):65-68.
[6]刘莹,丁传刚.16例小儿传染性单核细胞增多症临床分析[J].中国保健营养,2017,6(16):396.
[7]LUZURIAGA K,SULLIVAN J L.Infectious mononucleosis[J].N Eng J Med,2010,362(21):1993-2000.
[2]杨艳秋.EB病毒感染与传染性单核细胞增多症的相关性分析[J].临床输血与检验,2013,15(2):167.
[3]王小鹏,焦44,陈凌,等.不同年龄儿童传染性单核细胞增多症临床特点分析[J].教育生物学杂志,2017,5(1):37-41.
[4]谢明红.小儿传染性单核细胞增多症40例临床分析[J].临床检验杂志,2017,6(2):400.
[5]孙雨,王华,胡青华,等.不同年龄儿童传染性单核细胞增多症临床特征分析[J].临床误诊误治,2013,26(11):65-68.
[6]刘莹,丁传刚.16例小儿传染性单核细胞增多症临床分析[J].中国保健营养,2017,6(16):396.
[7]LUZURIAGA K,SULLIVAN J L.Infectious mononucleosis[J].N Eng J Med,2010,362(21):1993-2000.