不同年龄分期儿童传染性单核细胞增多症的临床分析  

Clinical analysis of infectious mononucleosis in different age stages of children

作　　者：刘瑞清[1] 王军[1] 张玉凤[1] 袁娟[1] 王小燕[1] 宋鹤 孙钊宁 孙欣荣[1] 唐甜甜 LIU Ruiqing;WANG Jun;ZHANG Yufeng;YUAN Juan;WANG Xiaoyan;SONG He;SUN Zhaoning;SUN Xinrong;TANG Tiantian(Second Department of Infection,Xi′an Children′s Hospital,Xi′an,Shaanxi 710003,China)

机构地区：[1]西安市儿童医院感染二科,陕西西安710003

出　　处：《检验医学与临床》2023年第18期2638-2644,共7页Laboratory Medicine and Clinic

基　　金：陕西省西安市创新能力强基计划-医学研究项目(21YXYJ0014)。

摘　　要：目的分析总结不同年龄分期儿童传染性单核细胞增多症(IM)的临床特点,提高临床医师对儿童IM的认识与诊断水平。方法根据小儿年龄分期分为婴幼儿组(<3岁)、学龄前期组(3~<6岁)、学龄期组(6~<10岁)和青春期组(≥10岁),回顾性分析2018年1月至2021年12月西安市儿童医院收治的468例IM患儿的临床资料,包括基本信息、临床症状、入院体征、并发症、病程中首次实验室指标,分析比较4个年龄组IM患儿的临床特点。结果468例IM患儿中婴幼儿组127例(27.14%),学龄前期组205例(43.80%),学龄期组115例(24.57%),青春期组21例(4.49%),4个年龄组间性别、发病季节构成比比较,差异均无统计学意义(P>0.05)。婴幼儿组脾大的发生率低于其余3个年龄组(P<0.05);学龄期组热程、住院天数以及咽痛的发生率大于婴幼儿组、学龄前期组(P<0.05);青春期组热程大于婴幼儿组、学龄前期组(P<0.05),乏力和咽痛的发生率高于其余3个年龄组(P<0.05)。234例(50.00%)IM患儿存在并发症,发生率位居前三的是肝损害(25.85%)、继发性粒细胞减少(19.44%)和心肌损害(11.97%)。学龄期组并发症总发生率高于婴幼儿组、学龄前期组(P<0.05),肝损害发生率明显高于婴幼儿组、学龄前期组(P<0.001)。4个年龄组肝损害均以轻度为主,学龄期组丙氨酸氨基转移酶(ALT)水平升高和天冬氨酸氨基转移酶(AST)水平升高的发生率均高于婴幼儿组、学龄前期组(P<0.05)。学龄期组肌酸激酶同工酶升高的发生率明显低于婴幼儿组、学龄前期组(P<0.05)。学龄期组、青春期组淋巴细胞百分率升高的发生率高于婴幼儿组、学龄前期组(P<0.05)。364例IM患儿淋巴细胞亚群检测主要表现为Th细胞比例降低、Ts细胞比例升高、Th/Ts比值降低、B淋巴细胞比例降低。4个年龄组间Th细胞比例、Ts细胞比例、Th/Ts比值、B淋巴细胞比例比较,差异均有统计学意义(P<0.001),但学龄期组与�Objective To analyze and summarize the clinical characteristics of infectious mononucleosis(IM)in different age stages of children in order to improve the understanding and diagnosis level of doctors for IM in children.Methods The children were divided into the infants and young children group(<3 years old),preschool-age group(3-<6 years old),school-age group(6-<10 years old)and adolescent group(≥10 years old)according to the age stage of children,and the clinical data of 468 children with IM in Xi′an Children′s Hospital from January 2018 to December 2021 were retrospectively analyzed,including the basic information,clinical symptoms,admission signs,complications,first laboratory indicators during the course of the disease,and the clinical characteristics of children patients with IM were analyzed and compared among the four age groups.Results Among 468 children patients with IM,there were 127 cases(27.14%)in the infants and young children group,205 cases(43.80%)in the preschool-age group,115 cases(24.57%)in the school-age group and 21 cases(4.49%)in the adolescent group.There was no statistically significant difference in the gender and seasonal composition proportions among the four age groups(P>0.05).The incidence rate of spleen enlargement in the infants and young children group was lower than those in the other three age groups(P<0.05).The heat course,hospital stay and pharyngeal pain occurrence rate in the school-age group were greater than those in the infants and young children group and preschool-age group(P<0.05).The fever duration of the adolescent group was greater than those of the infants and young children group and preschool-age group(P<0.05),and the incidence rates of fatigue and sore throat were higher than those of the other three age groups(P<0.05).There were 234 IM children patients(50.00%)with complications,its top three were liver damage(25.85%),secondary granulocytosis(19.44%)and myocardial damage(11.97%).The total incidence rate of complications in the school-age group was higher th

关 键 词：传染性单核细胞增多症 儿童 年龄分期 临床特点 淋巴细胞亚群 肝损害 

分 类 号：R725.1[医药卫生—儿科]