儿童传染性单核细胞增多症的临床特征及并发肝损害的相关因素分析

发布时间：2018-08-21 10:17

【摘要】：目的分析儿童传染性单核细胞增多症(infectious mononucleosis,IM)的临床特征,以及肝功能损害的相关因素,以期早期发现和干预IM伴肝功能损害。方法回顾性分析102例IM住院患儿的临床资料,对IM患儿的人口学特征,临床表现,实验室检查,并发症等进行统计学分析。并对56例伴肝功能损害的IM患儿的年龄、性别、发病季节、疾病严重程度等因素进行统计学分析,得出是否存在相关性。结果1、102例住院患儿,男女比例为2.29:1,男多于女。年龄分布在8个月~12岁10个月,平均年龄为(4.75±2.82)岁。3~7岁组人数最多。IM发病高峰为秋季。2、IM患者临床症状中,发热、颈部淋巴结肿大和咽峡炎为IM典型的三联征。咽峡炎,肝肿大和眼睑浮肿的发病率年幼儿大于年长儿,随着年龄的增长,发病率逐渐降低。3、实验室检查中,白细胞、CRP、PCT、铁蛋白升高在年长儿组比在婴幼儿组中更为常见。血清ALT和AST的值婴儿期组均明显低于年长儿组,随着年龄的增长,肝转氨酶出现升高的趋势。4、IM主要并发症包括肺炎,血小板减少,中性粒细胞减少症,和其他血液系统问题。肺炎是最常见的并发症,肺实质损害性肺炎的发病率随年龄增长而升高。5、存在肝功能损害的IM患者的年龄有显著性差异,年龄越大,肝损伤的可能性越大。发病季节因素在合并肝功能损害的IM患者中有统计学差异,秋季发病率最高(81.80%),春季其次,且与夏季及冬季相比有统计学意义。病程越长,发热时间越长,肝损伤的可能性越大,差别有统计学意义。轻度组与中度及重度组相比存在显著性差异,考虑病情较重的患儿更易发生肝功能损害。结论1.IM的住院患儿主要是以学龄前儿童为主,3到7岁组最多。绝大多数的患儿伴有发热、颈部淋巴结肿大和咽峡炎等临床表现。患儿的临床症状,体征,实验室检查结果和并发症随着年龄的增长而变化,但预后良好。2.IM患儿并发肝功能损害与患儿的年龄、季节、发热持续时间、病程、病情严重程度有相关性。临床上一般采用抗病毒及对症治疗。临床上应该对于存在严重并发症的病例特别注意,早期诊断与干预IM伴肝功能损害。
[Abstract]:Objective to analyze the clinical characteristics of infectious mononucleosis IM (IM) and the related factors of liver function damage in order to detect and intervene IM with liver function damage early. Methods the clinical data of 102 inpatients with IM were analyzed retrospectively. The demographic characteristics, clinical manifestations, laboratory examination and complications were analyzed statistically. The age, sex, onset season and severity of the disease were statistically analyzed in 56 cases of IM with liver dysfunction. Results the ratio of male to female was 2.29: 1 in 1102 hospitalized children. The mean age was (4.75 卤2.82) years old. The highest incidence peak of IM was in autumn. The fever, neck lymph node enlargement and pharyngitis were typical triple sign of IM. The incidence of pharyngitis, hepatomegaly and blepharoplegia in young children is higher than that in older children. With the increase of age, the incidence rate decreases gradually. In laboratory examination, elevated levels of leukocyte and ferritin are more common in the older children than in the infants. The levels of serum ALT and AST in infancy group were significantly lower than those in older children group. With the increase of age, the main complications of hepatic aminotransferase were pneumonia, thrombocytopenia, neutropenia, and other blood system problems, and the main complications were pneumonia, thrombocytopenia, neutropenia, and other blood system problems. Pneumonia is the most common complication. The incidence of pulmonary parenchymal pneumonia increases with age. There is a significant difference in the age of IM patients with liver function damage. The older the age, the greater the likelihood of liver injury. The incidence rate in autumn was the highest (81.80%), followed in spring, and had statistical significance compared with summer and winter. The longer the course, the longer the febrile time, the greater the possibility of liver injury, the difference is statistically significant. There was significant difference between mild group and moderate and severe group. Conclusion the majority of hospitalized children with 1.IM are preschool children aged 3 to 7 years. The vast majority of children with fever, cervical lymphadenopathy and pharyngitis and other clinical manifestations. Clinical symptoms, signs, laboratory findings and complications varied with age, but the prognosis was good. 2. Liver function damage and age, season, duration of fever, course of disease in IM children. The severity of the disease is related. General clinical use of antiviral and symptomatic treatment. Special attention should be paid to the early diagnosis and intervention of IM with liver dysfunction in patients with severe complications.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1

【参考文献】