儿童传染性单核细胞增多症并发心肌损害的影响因素分析  

Analysis of related influencing factors of infectious mononucleosis complicated by myocardial damage in children

作　　者：刘晶[1] 牟春燕 杜秋燕 Liu Jing;Mou Chun-yan;Du Qiu-yan(Department of Pediatric Infectious Diseases,Children's Hospital,Baoji Maternal and Child Health Hospital,Baoji,Shaanxi 721000,China;Department of Pediatrics,Xianyang Hospital of Yan'an University,Xianyang,Shaanxi 712000,China)

机构地区：[1]宝鸡市妇幼保健院儿童医院儿童感染科,陕西宝鸡721000 [2]延安大学咸阳医院儿科,陕西咸阳712000

出　　处：《中国现代医学杂志》2025年第7期33-38,共6页China Journal of Modern Medicine

基　　金：陕西省自然科学基础研究计划(No:2022JQ-935)。

摘　　要：目的分析儿童传染性单核细胞增多症(IM)并发心肌损害的影响因素,为临床诊治提供科学依据。方法回顾性选取2023年2月-2024年2月宝鸡市妇幼保健院儿童医院116例IM患儿为研究对象,根据患儿是否出现心肌损害,将其分为心肌损害组(25例)与无心肌损害组(91例)。对比两组患儿的一般资料、发病季节、临床表现,以及肝功能、血常规、免疫功能、心肌酶谱、心电图等。采用多因素一般Logistic回归模型分析IM患者发生心肌损害的影响因素。结果与无心肌损害组比较,心肌损害组临床表现(胸闷胸痛、心动过速)、心电图特征(ST改变、T波动、ST-T改变)患儿占比较高(P<0.05),且免疫功能指标(IgA、IgM、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、EBV DNA)及ALT水平较高(P<0.05)。两组发病季节、临床表现(发热、咽峡炎、淋巴结肿大、眼睑浮肿、肝肿大、脾肿大、皮疹、心音低钝)、血常规、肝功能指标(γ-GT、ALP、TBiL、DBiL)、IgG比较,差异均无统计学意义(P>0.05)。多因素一般Logistic回归分析结果显示,EBV DNA载量上升[OR=3.623(95%CI:1.284,10.222)]是IM患儿并发心肌损害的危险因素(P<0.05)。结论EBV DNA载量升高是IM患儿并发心肌损害的危险因素,应加强对该高风险群体的监测和早期干预,以降低心肌损害的发生率并改善患儿的预后。Objective To analyze the related influencing factors of infectious mononucleosis(IM)complicated by myocardial damage in children and provide scientific basis for clinical diagnosis and treatment.Methods A total of 116 children with IM,admitted to the Children’s Hospital of Baoji Maternal and Child Health Hospital from February 2023 to February 2024,were retrospectively selected as the subjects of this trial.According to the occurrence of myocardial damage in the children,they were divided into myocardial damage groups(n=25)and no myocardial damage group(n=91).The general information,clinical symptoms and signs,liver function,blood routine,immune function,myocardial enzyme spectrum and electrocardiogram of the two groups of patients were compared.Logistic regression was used to analyze the risk factors for myocardial damage in patients with IM.Results Compared with patients in the non-myocardial damage group,the myocardial damage group had a higher proportion of children with clinical manifestations(chest tightness,chest pain,tachycardia),electrocardiogram(ST changes,T fluctuations,ST-T changes)(P<0.05),and had better immune function.Indicators(IgA,IgG,CD4^(+/),CD8^(+/),CD4^(+/)CD8^(+/),EBV DNA)and ALT levels were higher(P<0.05).Season of onset,clinical manifestations(angina,swollen lymph nodes,eyelid edema,hepatomegaly,splenomegaly,rash,dull heart sounds),blood routine,and liver function indicators(γ-GT,ALP,TBiL,DBiL)of the two groups and IgG,the differences were not statistically significant(P>0.05).Logistic regression analysis results showed that increased EBV DNA load[OR=3.623,(95%CI:1.284,10.222)]is a risk factor for myocardial damage in children with IM(P<0.05).Conclusion EBV DNA Elevated load is a risk factor for complicated myocardial damage in children with IM.Monitoring and early intervention of this high-risk group should be strengthened to reduce the incidence of myocardial damage and improve the prognosis of children.

关 键 词：传染性单核细胞增多症 心肌损害 儿童 临床特征 影响因素 

分 类 号：R725.1[医药卫生—儿科]