摘要
目的了解成人传染性单核细胞增多症的临床特点,探讨该类患者发生肝损伤的危险因素。方法收集并分析2015年1月—2019年12月西南医科大学附属医院收治的成人传染性单核细胞增多症患者的临床资料,根据是否发生肝损伤分为两组,使用单因素分析及logistic回归分析筛选出成人传染性单核细胞增多症发生肝损伤的独立危险因素。结果62例符合诊断标准的患者纳入研究,男37例,女25例,平均年龄(23.7±7.2)岁。临床表现典型三联症(发热、咽痛、颈淋巴结肿大)的患者19例(30.6%),白细胞计数增多36例(58.1%),淋巴细胞占比≥0.50有56例(90.3%),异型淋巴细胞占比≥0.10有55例(88.7%),肝损伤51例(82.3%)[转氨酶≤10倍正常值上限42例(42/51,82.4%)],脾脏肿大26例(41.9%),肝脏肿大11例(17.7%),EB病毒衣壳IgM抗体(EBV-CA-IgM)阳性34例(54.8%),EB病毒脱氧核糖核酸(EBV-DNA)定量中位数4.24 lg cp/mL,所有患者经治疗后均痊愈。两组性别、年龄、病程、淋巴细胞占比、中性粒细胞计数、单核细胞计数、异型淋巴细胞占比、EBV-CA-IgM阳性率、EBV-DNA定量比较差异无统计学意义(P>0.05);肝损伤组的白细胞计数、淋巴细胞计数高于非肝损伤组(P<0.05)。logistic回归分析显示淋巴细胞计数≥5×10~9/L是成人传染性单核细胞增多症发生肝损伤的独立危险因素(OR=34.637,P=0.038)。结论成人传染性单核细胞增多症患者症状不典型,发生肝损伤概率高,需结合相关检查确诊;外周血淋巴细胞计数≥5×10~9/L是成人传染性单核细胞增多症发生肝损伤的独立危险因素,治疗后多数患者预后良好。
Objective To understand the clinical features of infectious mononucleosis in adults and explore the risk factors for liver injury in these patients.Methods The clinical data of infectious mononucleosis in adults treated in the Affiliated Hospital of Southwest Medical University from January 2015 to December 2019 were collected and analyzed.The patients were divided into two groups in terms of the presence of liver injury.Univariate analysis and logistic regression analysis were conducted to identify independent risk factors for liver injury in adults with infectious mononucleosis.Results A total of 62 patients were analyzed,including 37 males and 25 females.The mean age of patients was(23.7±7.2)years old.Nineteen patients(30.6%)had typical triads(fever,sore throat,cervical lymphadenopathy).Increased white blood cell count was found in 36 cases(58.1%),lymphocyte ratio≥0.50 in 56 cases(90.3%),abnormal lymphocyte ratio≥0.10 in 55 cases(88.7%),and liver injury in 51 cases(82.3%).Transaminase≤10 times of the upper limit of normal was found in 42 cases(82.4%),spleen enlargement in 26 cases(41.9%),liver enlargement in 11 cases(17.7%),and positive Epstein-Barr virus(EBV)capsid IgM antibody(EBV-CA-IgM)in 34 cases(54.8%).The median value of EBV-deoxyribonucleic acid(DNA)was 4.24 lg cp/mL.All patients recovered after treatment.There was no statistically significant difference in sex,age,onset time,lymphocyte ratio,neutrophil count,monocyte count,abnormal lymphocyte ratio,EBV-CA-IgM positive rate,and level of EBV-DNA between the two groups(P>0.05).White blood cell and lymphocytes counts in liver injury group were higher than in non-liver injury group(P<0.05).Logistic regression analysis showed that lymphocyte count≥5×10~9/L was an independent risk factor for liver injury in adults with infectious mononucleosis(OR=34.637,P=0.038).Conclusions The symptoms of infectious mononucleosis in adults are atypical.The diagnosis should be based on relevant laboratory tests.The incidence of liver injury is high.Lymphocyte count
作者
肖科
彭颖
武正菊
钟利
XIAO Ke;PENG Ying;WU Zhengju;ZHONG Li(Department of Infectious Diseases,Department of Tuberculosis,Infection and Immunity Laboratory,the Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2021年第2期148-151,共4页
Chinese Journal of Infection and Chemotherapy
基金
四川省重点学科(传染病学)建设项目基金(SZD0421)。
