四川省广安市106例重症传染性单核细胞增多症患儿临床特征和治疗分析

目的 分析广安市重症传染性单核细胞增多症（IM）患儿临床特征,探讨以重组人干扰素α1b辅助阿昔洛韦的治疗效果,为临床防治重症IM提供经验依据。方法 选取2018年1月—2021年1月广安市人民医院收治106例重症IM患儿为对象,采用随机数字法分为观察组和对照组,对照组予阿昔洛韦治疗,观察组在对照组基础上予重组人干扰素α1b治疗,比较两组临床疗效、临床症状（退热、咽峡炎消失、颈部肿大淋巴结消退及肝脾肿大）消失时间,检测降钙素原（PCT）、血红蛋白（Hb）、C反应蛋白（CRP）、血小板计数（PLT）、天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、异型淋巴细胞、白细胞计数（WBC）、淋巴细胞及不良反应发生率。结果 106例重症IM患儿均出现发热症状,发热时间7.5~16.0（13.5±6.3）d。颈部淋巴结肿大占85.8%,咽喉肿痛占78.3%,咽峡部有伪膜覆盖占70.8%,肝肿大占41.5%,脾肿大占36.8%,眼睑浮肿占35.8%。观察组和对照组治疗有效率分别94.34％和75.47％,观察组高于对照组,差异有统计学意义（χ²=7.361,P<0.05）;治疗后观察组退热、咽峡炎消失、颈部肿大淋巴结消退和肝脾肿大消失时间均短于对照组,差异有统计学意义（χ²=12.958,5.478,4.707,6.709,P<0.01）。治疗后两组血清PCT、CRP、AST、LDH、CK、CK-MB及异型淋巴细胞、WBC的异常率均降低,淋巴细胞比例升高（P<0.05）,且观察组变化更明显,两组差异有统计学意义（P<0.05）。两组不良反应发生率差异无统计学意义（P>0.05）。结论 重组人干扰素α1b辅助阿昔洛韦治疗重症IM患儿疗效显著,可改善临床症状,降低严重因子和心肌酶谱,改善外周血细胞比例。

Clinical characteristics and treatment of 106 children with severe infectious mononucleosis in Guang ‘an,Sichuan

Objective To analyze the clinical characteristics of children with severe infectious mononucleosis (IM) in Guang’an city, and we investigate the therapeutic effects of recombinant human interferon α1b assisted acyclovir, so as to provide a basis for clinically effective prevention and treatment of severe cases. Methods A total of 106 children with severe IM admitted to Guang’an People’s Hospital were enrolled in this study between January 2018 and January 2021. They were divided into control group and observation group by random number table method. The control group was treated with acyclovir, and the observation group was treated with recombinant human interferon α1b based on the treatment of the control group. The clinical effects, disappearance time of clinical symptoms (fever, angina, cervical enlarged lymph nodes, hepatosplenomegaly), procalcitonin (PCT), hemoglobin (Hb), C-reactive protein (CRP), platelet count (PLT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase-MB (CK-MB), atypical lymphocytes, white blood cell count (WBC), lymphocytes, and the incidence of adverse reactions were compared between the two groups. Results In 106 children with severe IM, they all had fever, and the fever time was 7.5-16.0 (13.5±6.3) days. Cervical lymph node enlargement accounted for 85.8%, sore throat accounted for 78.3%, pharyngeal isthmus covered with pseudomembrane accounted for 70.8%, hepatomegaly accounted for 41.5%, splenomegaly accounted for 36.8%, eyelid edema accounted for 35.8%. The response rate in the observation group was higher than that in the control group (94.34% vs. 75.47%) (χ²=7.361,P<0.05). After treatment, the disappearance time of fever, angina, cervical enlarged lymph nodes and hepatosplenomegaly in the observation group was shorter than that in the control group (χ²=12.958,5.478,4.707,6.709,P<0.01). After treatment, the abnormal rates of serum PCT, CRP, AST, LDH, CK, CK-MB, abnormal lymphocytes and WBC in both groups were decreased, while the proportion of lymphocytes was increased (P<0.05). The abnormal rates of serum PCT, CRP, AST, LDH, CK, CK-MB, abnormal lymphocytes and WBC in observation group were lower than those in control group, and the proportion of lymphocytes was higher than that in control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Recombinant human interferon α1b assisted acyclovir is effective in the treatment of children with severe IM, which can improve clinical symptoms, reduce the severity factor and myocardial enzyme spectrum, improve the peripheral blood cell proportion.