成人传染性单核细胞增多症患者临床特点及脾大的相关因素分析  

Clinical features of infectious mononucleosis in adults and risk factors for splenomegaly

作　　者：倪红丽[1] 范凤霞[1] 涂厚义 NI Hongli;FAN Fengxia;TU Houyi(Department of otolaryngology head and neck surgery,Zigong Fourth People's Hospital,Sichuan,643000,China)

机构地区：[1]四川自贡市第四人民医院耳鼻咽喉头颈外科,643000

出　　处：《中国中西医结合耳鼻咽喉科杂志》2025年第2期119-123,107,共6页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的探讨成人传染性单核细胞增多症(IM)患者临床特点及脾大危险因素分析。方法回顾性分析2017年11月~2024年2月四川省自贡市第四人民医院收治的65例成人IM患者的临床资料,根据超声检查是否有脾大分为两组,分析两组的主要临床表现(咽痛、发热、颈淋巴结肿大),比较两组患者的性别、年龄、住院时间、发病季节、白细胞计数、淋巴细胞比率、淋巴细胞绝对值、中性粒细胞比率、中性粒细胞绝对值、单核细胞数、异型淋巴细胞比率、红细胞、血红蛋白、血小板、凝血酶原时间(PT)、国际标准化比值(INR)、激活部分凝血活酶时间(APTT)、EB病毒DNA阳性率、EB病毒IgM抗体阳性率、C-反应蛋白(CRP)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平的差异,探讨引起脾大的危险因素。结果65例符合诊断标准的患者中,男31例,女34例,平均年龄23.8岁(18~41岁)。临床表现有咽痛57例(87.7%),发热36例(55.4%),颈淋巴结肿大40例(61.5%),脾大者36例(55.4%)。白细胞计数增多37例(56.9%),淋巴细胞比率增多45例(69.2%),淋巴细胞绝对值增多52例(80%),中性粒细胞比率减少46例(70.8%),中性粒细胞绝对值减少6例(9.2%),单核细胞数增加34例(52.3%),65例患者中62例均可查见异形淋巴细胞,其中41例异型淋巴细胞比率≧0.10(63.1%),EB病毒DNA阳性60例(92.3%)、EB病毒IgM抗体阳性53例(81.5%),CRP升高39例(60.0%),ALT升高52例(80.0%),AST升高45例(69.2%),所有患者经治疗后痊愈。两组患者性别、年龄、住院时间、发病季节、白细胞计数、淋巴细胞比率、淋巴细胞绝对值、中性粒细胞比率、中性粒细胞绝对值、单核细胞数、红细胞、血红蛋白、血小板、凝血酶原时间、国际标准化比值、激活部分凝血活酶时间、EB病毒DNA阳性率、EB病毒IgM抗体阳性率、CRP以及典型临床表现的出现率比较差异无统计学意义(P>0.05),而异型淋巴细胞比率、ALT、AST为IM�Objective To investigate the clinical features and risk factors of splenomegalysis in adult infectious mononucleosis(IM).Methods The clinical data of 65 adults IM patients treated in the zigong Fourth People's Hospital of Zigong City from November 2017 to February 2024 were retrospectively analyzed.The patients were divided into two groups based on ultrasonography for splenomegaly.The main clinical manifestations(sore throat,fever,lymph node enlargement)of the two groups were analyzed.The gender,age,length of stay,season of onset,white blood cell count,lymphocyte ratio,absolute value of lymphocytes,neutrophil ratio,neutrophil ratio,absolute value of neutrophil,monocyte count,allotypic lymphocyte ratio,erythrocyte,hemoglobin,platelet,prothrombin time(PT),and International normalized ratio(INR),partial thromboplastin activation time(APTT),EBV DNA positive rate,EBV IgM positive rate,C-reactive protein(CRP),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)levels were compared between the two groups.To investigate the risk factors of splenomegaly.Results A total of 65 patients were analyzed,including 31 males and 4 females,?the mean age of patients was 23.8 years old(18-41 years).The clinical manifestations included throat pain in 57 cases(87.7%),fever in 36 cases(55.4%),cervical lymph enlargement in 40 cases(61.5%),and splenomegaly in 36 cases(55.4%).Leukocyte count increased in 37 cases(56.9%),lymphocyte ratio increased in 45 cases(69.2%),lymphocyte absolute value increased in 52 cases(80%),neutrophil ratio decreased in 46 cases(70.8%),neutrophil absolute value decreased in 6 cases(9.2%),monocyte count increased in 34 cases(52.3%).Heterogeneous lymphocytes were found in 62 of the 65 patients,of which the proportion of heterogeneous lymphocytes in 40 patients 0.10(63.1%).Epstein-barr virus DNA positive in 60 cases(92.3%),Epstein-Barr virus IgM antibody positive in 53 cases(81.5%),CRP increased in 39 cases(60.0%),ALT increased in 52 cases(80.0%),AST increased in 45 cases(69.2%).All patients recovered a

关 键 词：成人、传染性单核细胞增多症 EB病毒 脾大 危险因素 

分 类 号：R512.7[医药卫生—内科学]