长期未转阴新型冠状病毒肺炎患者儿童传染性单核细胞增多症临床特征及合并肝脏损害的危险因素分析

郭宏敏; 全晓会; 浮纪玲; 吴铭辉

文章摘要

长期未转阴新型冠状病毒肺炎患者儿童传染性单核细胞增多症临床特征及合并肝脏损害的危险因素分析

Clinical features of infectious mononucleosis in children and analysis of risk factors for concomitant liver damage

DOI：10.3969/j.issn.1007-8134.2022.06.008

中文关键词: 传染性单核细胞增多症临床特征儿童肝脏损害热程白细胞 EBV DNA载量危险因素

英文关键词: infectious mononucleosis clinical feature children liver damage heat duration WBC EBV DNA load risk factor

基金项目:

作者	单位
郭宏敏	新乡市第一人民医院儿科
全晓会	南阳，河南油田唐河基地医院儿科
浮纪玲	新乡市第一人民医院儿科
吴铭辉	郑州大学第一附属医院小儿内科

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中文摘要:

[摘要]?目的?分析儿童传染性单核细胞增多症（infectious mononucleosis, IM）临床特征及合并肝脏损害的危险因素，为临床早期诊断及治疗提供重要依据。方法?选取2015年1月—2020年12月我院收治的86例IM儿童作为研究对象，回顾性收集并分析其性别、年龄等人口学特征及发病季节、临床表现、实验室检查结果等临床资料。根据ALT水平将IM儿童分为肝脏损害组（ALT＞40 U/L，46例）和非肝脏损害组（ALT≤40 U/L，40例），评估影响儿童IM合并肝脏损害的危险因素。结果?86例IM儿童中，男性略多于女性（55.81% vs. 44.19%），发病年龄以3～7岁居多（52.33%），发病季节以秋季（31.40%）及春季（26.74%）居多，临床表现以发热（95.35%）、颈部淋巴结肿大（91.86%）、咽峡炎（63.95%）为主。白细胞增多36例（41.86%），异型淋巴细胞增多27例（31.40%），血小板减少7例（8.14%），CRP升高39例（45.35%），CK-MB升高11例（12.79%），ALT、AST升高分别为46例（53.49%）和44例（51.16%），EBV DNA为5.00×104 copies/ml～500.00×104 copies/ml的儿童37例（43.02%）。热程＞7 d、白细胞增多、EBV DNA＞500.00×104 copies/ml均为影响IM合并肝脏损害的危险因素（P均＜0.05）。结论?秋季与春季是儿童IM高发季节，学龄前期为好发年龄，发热、颈部淋巴结肿大、咽峡炎为其主要临床表现，患儿常伴多种实验室检查指标异常。热程较长、白细胞增多、EBV DNA载量较高的IM患儿应警惕肝脏损害，临床应予以重视。

英文摘要:

[Abstract]　Objective?To analyze the clinical features of infectious mononucleosis (IM) in children and the risk factors for concomitant liver damage, and to provide important basis for early clinical diagnosis and treatment. Methods?Eighty-six children with IM who were treated in our hospital between January 2015 and December 2020 were selected as the study subjects, and demographic characteristics such as gender and age, the clinical data such as onset season, clinical manifestations and laboratory examination results were retrospectively collected and analyzed. According to the level of ALT, the children with IM were divided into the liver damage group (ALT＞40 U/L, 46 cases) and the non-liver damage group (ALT≤40 U/L, 40 cases). The risk factors affecting IM with liver damage in children were evaluated. Results?Among 86 children with IM, the number of males was slightly more than the number of females (55.81% vs. 44.19%). The age of onset was mostly 3-7 years old (52.33%), and the seasons of onset were mostly autumn (31.40%) and spring (26.74%). The clinical manifestations were mainly fever (95.35%), cervical lymphadenectasis (91.86%), and angina (63.95%). There were 36 cases (41.86%) of leukocytosis, 27 cases (31.40%) of increased atypical lymphocytes, 7 cases (8.14%) of thrombocytopenia, 39 cases (45.35%) of elevated CRP, 11 cases (12.79%) of elevated CK-MB, 46 cases (53.49%) of elevated ALT, 44 cases (51.16%) of elevated AST and 37 cases (43.02%) of EBV DNA ranging from 5.00×104 copies/ml to 500.00×104 copies/ml. Heat duration＞7 d, leukocytosis and EBV DNA＞500.00×104 copies/ml were all risk factors affecting IM with liver damage (P＜0.05). Conclusions?Autumn and spring are the high-onset seasons of IM in children, and preschool age is the high-onset age, and fever, cervical lymphadenopathy and angina are the main clinical manifestations. Children with IM are often accompanied by a variety of laboratory examination abnormalities. IM children with long heat duration, leukocytosis and large EBV DNA loads should be alert to liver damage, which should be paid attention to in clinical practice.

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