成都地区传染性单核细胞增多症患儿早期危险指标分析

doi:10.3969/j.issn.1004-583X.2023.11.008

摘要/Abstract

摘要：

目的分析epstein-barr(EB)病毒感染、EB合并肺炎支原体(MP)、EB合并人巨细胞病毒(CMV)及EB同时合并MP、CMV感染所致传染性单核细胞增多症(IM)患儿的临床表现及其早期实验室检查相关指标的差异。方法选取2015年10月至2023年4月于成都市第二人民医院入院或初诊确诊为EB病毒检出阳性的IM患儿163例,并分为单纯EB病毒感染组、EB合并MP感染组、EB合并CMV感染组及EB合并MP+CMV感染组。收集患儿性别、年龄、临床症状及早期实验室各项相关指标,并进行统计学分析。结果 4组性别、年龄、发热、扁桃体肿大、淋巴结肿大等发生率比较,差异无统计学意义( $P$ >0.05)。单纯EB病毒感染组谷丙转氨酶(ALT)、谷草转氨酶(AST)及谷氨酰转肽酶(GGT)均高于EB合并MP感染组;GGT高于EB合并CMV感染组;ALT及GGT高于EB合并MP+CMV感染组( $P$ <0.05)。结论 IM患儿中单纯EB病毒感染者临床症状与EB合并感染者相似,但肝功能损害较EB合并感染者更严重,早期常规检测肝功能指标有助于临床早期诊治及预后。

关键词: 传染性单核细胞增多症, 疱疹病毒4型, 人, 巨细胞病毒, 肺炎支原体

Abstract:

Objective To analyze the different clinical manifestations and early laboratory risk for infectious mononucleosis (IM) in children caused by Epstein-Barr (EB) virus infection, EB virus infection combined with Mycoplasma pneumoniae (MP), EB virus infection combined with human cytomegalovirus (CMV) infection and EB virus infection combined with MP and CMV infection. Methods From October 2015 to April 2023, totally 163 children with IM patients and positive for EB virus who were admitted or first diagnosed in Chengdu Second People's Hospital were recruited. Among them, IM patients with EB virus infection were included in the experimental group, and those with EB virus infection combined with MP infection were included in the control group 1; those with EB virus infection combined with CMV infection were included in the control group 2; and those with EB virus infection combined with MP and CMV infection were included in the control group 3. Gender, age and clinical symptoms of children were collected, and the early laboratory indicators of infection were detected for statistical analyses. Results There were no significant differences in gender, age and incidence of clinical symptoms like fever, tonsil enlargement and lymph node enlargement among the four groups ( $P$ >0.05). Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and glutamyl transpeptidase (GGT) of the experimental group were significantly higher than those of the control group 1 ( $P$ <0.05). GGT of the experimental group was significantly higher than that of the control group 2( $P$ <0.05). ALT and GGT of the experimental group were significantly higher than those of the control group 3 ( $P$ <0.05). Conclusion The clinical symptoms of EB virus infection in children with IM are similar to those with the co-infection, but presenting severer liver function impairment. An early routine detection of risk factors for liver function favors early clinical diagnosis and treatment and thus improves the prognosis.

Key words: infectious mononucleosis, Epstein-Barr virus, human cytomegalovirus, mycoplasma pneumonia, risk indicators

中图分类号:

R512.7

聂芳, 罗俊. 成都地区传染性单核细胞增多症患儿早期危险指标分析[J]. 临床荟萃, 2023, 38(11): 1008-1011.

Nie Fang, Luo Jun. Analysis of early risk factors for infectious mononucleosis in children from Chengdu city[J]. Clinical Focus, 2023, 38(11): 1008-1011.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.11.008

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I11/1008

图/表 1

表1 4组临床资料及实验室指标的比较[( x -±s),例(%)]

Tab. 1 Comparison of clinical data and laboratory index between groups([ x -±s],n[%])

组别		例数	年龄(岁)			发热		扁桃体肿大			淋巴结肿大		N(%)		WBC(×10⁹/L)		HL(%)
单纯EB病毒感染组		71	6.27±4.41			64(90.14)		67(94.37)			64(90.14)		28.13±9.88		14.56±5.04		19.31±10.65
EB合并MP感染组		33	6.38±3.73			29(87.88)		32(96.97)			32(96.97)		23.08±7.23		16.84±6.81		18.23±12.04
EB合并CMV感染组		30	4.80±1.81			27(90.00)		30(100.00)			28(93.33)		27.99±10.25		16.85±6.83		22.90±11.99
EB合并MP+CMV感染组		29	5.11±2.76			28(96.55)		29(100.00)			27(93.10)		22.99±9.48		16.53±6.18		23.44±16.52
$F$ /χ²值			1.768			1.545		3.440			0.789		1.357		0.988		1.508
$P$ 值			0.155			0.672		0.329			0.852		0.262		0.403		0.215
组别		C-RP(mg/L)			ALT(U/L)				AST(U/L)			DBIL(μmol/L)		TBIL(μmol/L)		ALP(U/L)
单纯EB病毒感染组		10.52±12.42			112.80±105.18				85.59±81.28			2.48±1.96		6.65±3.51		252.76±121.78
EB合并MP感染组		14.24±21.89			49.33±29.28*				59.07±20.82			1.95±1.06		5.83±2.26		244.54±77.04
EB合并CMV感染组		14.25±22.47			60.50±45.29*				61.10±41.17			2.35±0.73		7.20±1.69		236.50±58.50
EB合并MP+CMV感染组		13.45±13.00			59.14±29.60*				46.00±16.03*			2.33±1.17		7.36±3.37		201.29±30.57
$F$ /χ²值		0.578			7.859				3.979			0.217		0.042		0.011
$P$ 值		0.631			0.001				0.014			0.642		0.838		0.918
组别	GGT(U/L)			Mb(μg/L)			CK-MB(μg/L)			HsTnl(μg/L)			CK(U/L)		HBDH(U/L)		LDH(U/L)
单纯EB病毒感染组	54.98±71.25			15.20±7.59			1.82±1.98			0.004±0.003			74.86±40.45		413.69±102.92		526.83±132.51
EB合并MP感染组	25.67±14.09^*			11.62±10.75			1.40±1.56			0.005±0.005			68.89±57.26		407.89±73.36		531.44±96.94
EB合并CMV感染组	15.89±8.34^*			12.89±12.42			1.54±1.43			0.006±0.005			62.56±26.99		371.33±42.74		468.22±174.96
EB合并MP+CMV感染组	13.43±6.24^*			16.45±11.95			2.40±2.55			0.005±0.004			51.50±47.42		431.00±83.26		481.50±181.32
$F$ /χ²值	8.081			1.597			1.584			1.846			2.105		2.674		1.775
$P$ 值	0.001			0.192			0.195			0.141			0.102		0.061		0.154

表1 4组临床资料及实验室指标的比较[( x -±s),例(%)]

Tab. 1 Comparison of clinical data and laboratory index between groups([ x -±s],n[%])

组别		例数	年龄(岁)			发热		扁桃体肿大			淋巴结肿大		N(%)		WBC(×10⁹/L)		HL(%)
单纯EB病毒感染组		71	6.27±4.41			64(90.14)		67(94.37)			64(90.14)		28.13±9.88		14.56±5.04		19.31±10.65
EB合并MP感染组		33	6.38±3.73			29(87.88)		32(96.97)			32(96.97)		23.08±7.23		16.84±6.81		18.23±12.04
EB合并CMV感染组		30	4.80±1.81			27(90.00)		30(100.00)			28(93.33)		27.99±10.25		16.85±6.83		22.90±11.99
EB合并MP+CMV感染组		29	5.11±2.76			28(96.55)		29(100.00)			27(93.10)		22.99±9.48		16.53±6.18		23.44±16.52
$F$ /χ²值			1.768			1.545		3.440			0.789		1.357		0.988		1.508
$P$ 值			0.155			0.672		0.329			0.852		0.262		0.403		0.215
组别		C-RP(mg/L)			ALT(U/L)				AST(U/L)			DBIL(μmol/L)		TBIL(μmol/L)		ALP(U/L)
单纯EB病毒感染组		10.52±12.42			112.80±105.18				85.59±81.28			2.48±1.96		6.65±3.51		252.76±121.78
EB合并MP感染组		14.24±21.89			49.33±29.28*				59.07±20.82			1.95±1.06		5.83±2.26		244.54±77.04
EB合并CMV感染组		14.25±22.47			60.50±45.29*				61.10±41.17			2.35±0.73		7.20±1.69		236.50±58.50
EB合并MP+CMV感染组		13.45±13.00			59.14±29.60*				46.00±16.03*			2.33±1.17		7.36±3.37		201.29±30.57
$F$ /χ²值		0.578			7.859				3.979			0.217		0.042		0.011
$P$ 值		0.631			0.001				0.014			0.642		0.838		0.918
组别	GGT(U/L)			Mb(μg/L)			CK-MB(μg/L)			HsTnl(μg/L)			CK(U/L)		HBDH(U/L)		LDH(U/L)
单纯EB病毒感染组	54.98±71.25			15.20±7.59			1.82±1.98			0.004±0.003			74.86±40.45		413.69±102.92		526.83±132.51
EB合并MP感染组	25.67±14.09^*			11.62±10.75			1.40±1.56			0.005±0.005			68.89±57.26		407.89±73.36		531.44±96.94
EB合并CMV感染组	15.89±8.34^*			12.89±12.42			1.54±1.43			0.006±0.005			62.56±26.99		371.33±42.74		468.22±174.96
EB合并MP+CMV感染组	13.43±6.24^*			16.45±11.95			2.40±2.55			0.005±0.004			51.50±47.42		431.00±83.26		481.50±181.32
$F$ /χ²值	8.081			1.597			1.584			1.846			2.105		2.674		1.775
$P$ 值	0.001			0.192			0.195			0.141			0.102		0.061		0.154

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