传染性单核细胞增多症124例临床分析

目的探讨小儿传染性单核细胞增多症 (IM)的临床特征、诊断与治疗方法。方法回顾分析 12 4例确诊为IM患儿的临床资料和治疗效果。结果IM发病 3岁以下占 5 1.6 % ;发热、咽峡炎、肝脾及淋巴结肿大典型临床表现发生率均在 90 %以上 ,而鼻塞、眼睑水肿、皮疹、尿少等不常见临床表现发生率也较高 (约占 10 %～ 32 % ) ;外周血异形淋巴细胞 >10 % 92例 (72 .6 % ) ,嗜异性凝集试验阳性 2 2 .9% (2 5 / 10 9) ,VCA IgM阳性 76 .7% (2 3/ 30 ) ,EBV DNA阳性 16例(16 / 4 3) ,合并支原体感染 32 .4 % (12 / 37)。干扰素或更昔洛韦治疗组均较利巴韦林和莪术油组的临床症状、体征恢复快 (P <0 .0 5 )。结论IM发病年龄呈提前趋势 ,且合并支原体感染者增多 ,其临床表现既相对集中 ,又呈多样性。VCA IgM和EBV DNA检测可提高对不典型IM的早期诊断。干扰素、更昔洛韦明显提高IM近期疗效。

Clinical analysis of 124 cases of infectious mononucleosis

Objective To explore the clinical features, diagnosis and treatment of children infectious mononucleosis(IM). Methods Clinical data of 124 children patients with IM were analyzed retrospectively. Results The onset under 3 years old accounted for 51.6%. The incidence of typical clinical manifestation such as fever, angina, hepatosplenomegaly and lymph nodes enlarged were more than 90%, that of atypical ones, such as stuffy nose, edema of eye lids, rash and oliguria were also rather high(10%-32%). Atypical lymphocytes >0.10 in the peripheral blood were detected in 92 cases(72.6%). The positive rates of Paul-Bunnell test, VCA-IgM and EBV-DNA were 22.9%(25/109), 76.7%(23/30) and 37.2%(16), respectively. Mycoplasma infection complicated was 32.4% (12/37). The therapy of interferon or ganciclovir shortened recovery period more rapidly than that of ribavirin or zedoary turmeric oil(p<0.05). Conclusion Although the onset of IM becomes younger and the incidence of mycoplasma infection complicated is getting higher, while the clinical features of IM are rather localized and diversified, so the detection of VCA-IgM and EBV-DNA can improve the early diagnosis and interferon or ganciclovir can remarkably improve short-term therapeutic effect of IM.