儿童传染性单核细胞增多症的临床特点及误诊原因分析  

Clinical characteristics and misdiagnosis analysis of infectious mononucleosis in children

作　　者：刘瑞清[1] 孙钊宁 唐甜甜 张玉凤[1] 王军[1] 徐鹏飞[1] 杨希茹 宋鹤 李洁 孙欣荣[1] Liu Ruiqing;Sun Zhaoning;Tang Tiantian;Zhang Yufeng;Wang Jun;Xu Pengfei;Yang Xiru;Song He;Li Jie;Sun Xinrong(The Second Department of Infectious Diseases,Xi′an Children′s Hospital,Xi′an 710003,China)

机构地区：[1]西安市儿童医院感染二科,西安710003

出　　处：《中国医师进修杂志》2022年第9期777-782,共6页Chinese Journal of Postgraduates of Medicine

基　　金：西安市创新能力强基计划-医学研究项目(21YXYJ0014)。

摘　　要：目的总结儿童传染性单核细胞增多症(IM)的临床特点、误诊原因及防范措施,提高临床医师对儿童IM早期诊断的能力。方法回顾性分析2018年1月至2021年12月西安市儿童医院468例IM患儿的临床资料,包括一般情况、起病情况、就诊情况以及误诊情况。结果 468例患儿中,临床诊断33例,确诊435例;男281例(60.04%),女187例(39.96%);学龄前儿童发病率最高[43.80%(205/468)],秋季发病率最高[33.12%(155/468)]。首发症状以发热[52.99%(248/468)]、眼睑水肿[15.38%(72/468)]和颈部包块[14.96%(70/468)]为主。发热率为90.38%(423/468),中位首次发热时间为病程第1(1,2)天,中位热程为6(4,8)d。中位首次就诊时间为病程第3(1,5)天,确诊时间为病程第7(5,9)天。血常规示白细胞计数升高比例为51.92%(243/468),淋巴细胞百分率升高比例为61.75%(289/468),外周血异型淋巴细胞比率升高(≥10%)率为58.97%(276/468)。364例患儿行淋巴细胞亚群检测,辅助性T淋巴细胞(Th细胞)比例降低率为80.22%(292/364),抑制性T淋巴细胞(Ts细胞)比例升高率为99.45%(362/364),Th细胞/Ts细胞0.24(0.16,0.40)、降低率为100.00%(364/364),B淋巴细胞比例降低率为93.96%(342/364),自然杀伤细胞比例降低率为35.16%(128/364)、升高率为0.55%(2/364)。误诊发生率为55.13%(258/468),误诊时间为5(4,7)d;258例误诊患儿中,误诊为上呼吸道感染105例(40.70%),急性化脓性扁桃体炎65例(25.19%),急性颈部淋巴结炎或颈部包块待查27例(10.47%)。结论儿童IM临床表现复杂多样,病程早期容易误诊。临床医师需掌握儿童IM的临床特点,不断提高诊治水平,降低误诊率。Objective To summarize the clinical characteristics,causes of misdiagnosis and preventive measures of infectious mononucleosis(IM)in children,and to improve the ability of clinicians in early diagnosis of IM in children.Methods The clinical data of 468 children with IM in Xi′an Children′s Hospital from January 2018 to December 2021 were retrospectively analyzed,including general situation,disease onset,diagnosis and misdiagnosis.Results Among the 468 children,33 cases were clinically diagnosed and 435 cases were a definitely diagnosed;281 males(60.04%)and 187 females(39.96%);the incidence rate was highest in preschool children(43.80%,205/468)and in autumn(33.12%,155/468).The first symptoms were fever(52.99%,248/468),eyelid edema(15.38%,72/468)and neck mass(14.96%,70/468).The fever rate was 90.38%(423/468),and the median time of first fever appearance was on the first(first,second)day of disease course,and the median duration of fever was 6(4,8)d.The median time of first visit was on the third(first,fifth)day of disease course,and the time of diagnosis was on the seventh(fifth,ninth)day of disease course.Blood routine examination showed that the proportion of white blood cell count increased was 51.92%(243/468),the proportion of lymphocytes increased was 61.75%(289/468),and the proportion of abnormal lymphocytes increased(≥10%)in peripheral blood was 58.97%(276/468).The lymphocyte subsets of 364 children were detected,the rate of helper T lymphocytes(Th cells)decreased was 80.22%(292/364),the rate of suppressor T lymphocytes(Ts cells)increased was 99.45%(362/364),the value and decreased rate of Th cells/Ts cells were 0.24(0.16,0.40)and 100.00%(364/364),rate of B lymphocytes decreased was 93.96%(342/364),rates of natural killer cells decreased and increased were 35.16%(128/364)and 0.55%(2/364).The misdiagnosis rate was 55.13%(258/468),and the misdiagnosis time was on the fifth(fourth,seventh)day of disease course.Among the 258 misdiagnosed children,105 cases(40.70%)were misdiagnosed as upper respiratory tract

关 键 词：儿童 传染性单核细胞增多症 疱疹病毒4型 人 疾病特征 误诊 

分 类 号：R725.1[医药卫生—儿科]