中国实用儿科杂志

中国实用儿科杂志 ›› 2025, Vol. 40 ›› Issue (4): 325-330.DOI: 10.19538/j.ek2025040611

• 论著 • 上一篇    下一篇

131例传染性单核细胞增多症患儿临床特征及肝损伤相关危险因素分析

  

  1. 浙江大学医学院附属儿童医院  a 消化科与儿童内镜中心，b 麻醉科  国家儿童健康与疾病临床医学研究中心  国家儿童区域医疗中心（杭州），浙江  杭州  310052
  • 出版日期:2025-04-06 发布日期:2025-05-13
  • 通讯作者: 江米足，电子信箱：mizu@zju.edu.cnq

Clinical characteristics of 131 cases of infectious mononucleosis in pediatric patients and analysis of the risk factors for liver injury

  1. *Department of Gastroenterology and Pediatric Endoscopy Center，Children's Hospital Affiliated to Medical College of Zhejiang University，National Clinical Research Center for Child Health，National Children’s Regional Medical Center，Hangzhou  310052，China
  • Online:2025-04-06 Published:2025-05-13

摘要： 目的　探讨儿童传染性单核细胞增多症（IM）一般临床特征和肝损伤相关危险因素，总结临床诊治经验。方法　回顾性分析浙江大学医学院附属儿童医院2020年7月至2021年8月诊断为IM的131例患儿资料，收集性别、年龄、病程、临床表现、实验室检查、影像学检查和病情转归等临床资料。结果　131例IM患儿中，76.3%（100/131）有肝损伤。与肝功能正常组患儿相比，肝损伤组患儿肝大占比（38.7% vs. 64%，P=0.013）和脾大占比（41.9% vs.75%，P=0.001）均显著增加，年龄［（4.0±2.1）岁 vs.（5.4±3.2）岁，P=0.012］、病程中位数（12 d vs. 19 d，P=0.001）、血红蛋白［（119.94±13.99）g/L vs. （124.55±10.34） g/L，P=0.008］、异型淋巴细胞占比（2% vs. 6%，P=0.001）、EB病毒DNA拷贝数（0 vs. 2.7×106/L，P=0.015）均显著上升，差异均有统计学意义。Logistic回归分析结果表明，年龄（OR 1.323；95% CI 1.046～1.675，P=0.02）、女性（OR 3.225，95% CI 1.178～8.833，P=0.023）和异型淋巴细胞比率增高（OR 1.216，95% CI 1.054～1.402，P=0.007）是IM并发肝损伤的高危因素。结论　IM患儿临床特征复杂多变，其中肝损伤发生与性别、年龄和异型淋巴细胞比率增高有关，提高了对儿童IM临床特征及肝损伤相关危险因素的认识。

关键词: 儿童, 传染性单核细胞增多症, EB病毒, 肝损伤

Abstract: Objective　To explore the general clinical characteristics and risk factors for liver injury in children with infectiousmononucleosis（IM），and summarize the clinical experience in diagnosis and treatment. Methods　Retros-pective analysis of 131 cases of children with IM was performed， who were hospitalized in Children's Hospital Affiliated to Zhejiang University School of Medicine from July 2020 to August 2021.Clinical data， including gender，age，course of disease，clinical manifestations，laboratory examination，imaging examination and disease outcome， were collected.Results　Among 131 children with IM，76.3%（100/131）were considered to have liver injury（ALT>40 U/L）.Compared with normal liver injury group，the percentage of hepatomegaly（38.7% vs.64%，P=0.013）and splenomegaly（41.9% vs.75%，P=0.001）was significantly increased in the liver injury group，and so were age［（4.0±2.1）vs.（5.4±3.2）］ （P=0.012），median disease duration（12 d vs.19 d，P=0.001），hemoglobin［（119.94±13.99）g/L vs.（124.55±10.34） g/L］ （P=0.008），abnormal lymphocyte ratio（2%vs.6%，P=0.001），and EBV DNA copy number（0 vs. 2.7×106copies/L，P=0.015）. Logistic regression analysis results showed that age（OR 1.323；95%CI  1.046-1.675，P=0.02），female（OR 3.225，95% CI 1.178-8.833，P=0.023）and abnormal lymphocyte ratio（OR 1.216，95% CI 1.054-1.402，P=0.007）were high-risk factors for IM complicated with liver injury. Conclusion　The clinical characteristics of children with IM are complex and changeable.Liver injury of IM is related to gender，age and increase in abnormal lymphocyte rate.The understanding of clinical features of IM in children and the risk factors for liver injury is improved.

Key words: child, infectious mononucleosis, Epstein-Barr virus, liver injury