传染性单核细胞增多症合并肝损伤患儿的临床特点

摘要/Abstract

摘要： 目的分析传染性单核细胞增多症(IM)合并肝损伤患儿的临床特点。方法纳入2023 年 1 月 1 日至 12 月 31 日于西安交通大学附属儿童医院感染科确诊为的IM患儿231例,比较肝损伤组与非肝损伤组的临床特征及相关实验室检查。结果发生肝损伤的患儿共126例(54.54%),男性50例(39.68%),女性76例(60.32%);婴儿期0例,幼儿期11例(8.73%),学龄前期67例(53.17%),学龄期47例(37.30%),青春前期1例(0.79%)。发病年龄70(47,104)个月。肝损伤组患儿住院时间为7(6,8)d,非肝损伤组为6(5,7)d,(P<0.05)。肝损伤组患儿异型淋巴细胞百分率[15.50(11.00,22.00)]、EB病毒定量[812.50(0.00,2400.00)]、IgM[1.64(1.29,2.20)]及Ts细胞(抑制性T细胞)比例[64.00(57.00,71.00)]均高于非肝损伤组的13.00(9.00,20.00)、0.00(0.00,1240.00)、1.36(1.08,1.88)、59.00(52.00,67.00);而肝损伤组患儿Th细胞(辅助性T细胞)比例[13.50(10.00,19.00)]及B细胞比例[4.00(3.00,6.00)]均低于非肝损伤组16.00(12.00,21.00)、6.00(4.00,8.00),差异均有统计学意义(P<0.05);两组IgA、IgG和NK细胞计数差异无统计学意义(P>0.05)。结论女性及学龄前期IM患儿更易合并肝损伤。IM有无肝损伤与异型淋巴细胞百分率、EB病毒载量及细胞免疫存在一定相关性。肝损伤患儿易发生免疫功能紊乱。

关键词: 传染性单核细胞增多症, 肝损伤, 异型淋巴细胞百分率, EB病毒DNA定量, 体液免疫, 淋巴细胞亚群

Abstract: Objective To analyze the clinical features of children with infectious mononucleosis (IM) complicated with liver damage. Methods Hospitalized children diagnosed with infectious mononucleosis in the Department of Infectious Diseases, Children′s Hospital of Xi′an Jiaotong University from January 1 to December 31, 2023 were collected as research subjects. According to the results of liver function examination, patients were divided into liver damage group (n=126) and non-liver damage group (n=105), and the clinical features and related laboratory tests were compared between the two groups. Results A total of 231 IM cases were collected, of which 126 cases (54.54%) developed liver damage, among them, 50 cases (39.68%) were male and 76 cases (60.32%) were female. There were 0 infants, 11 early childhood (8.73%), 67 pre-school-age patients (53.17%), 47 school-age patients (37.30%), and 1 pre-youth patient (0.79%).The proportion of female children in liver damage group was higher than that in male children (60.32% vs 39.68%, P=0.000).The median age of onset was 70 (47,104) months, and the incidence of IM in preschool age (53.17%) and school-age children (37.3%) , higher than that in other age groups (P=0.001). The hospital stay days in the liver injury group was longer than that in the non-liver injury group [7 (6,8)] (P<0.05).The percentage of abnormal lymphocytes[15.50(11.00,22.00)], EB virus quantification[812.50(0.00,2400.00)], immunoglobulin (IgM) [1.64 (1.29,2.20)] and the percentage of Ts cells (inhibitory T cells) [64.00 (57.00,71.00)] in the liver injury group were higher than those in the non-liver injury group [13.00 (9.00,20.00)], EB virus quantification [0.00 (0.00, 1240.00)], immunoglobulin (IgM) [1.36 (1.08,1.88)] and the proportion of Ts cells (inhibitory T cells) [59.00 (52.00, 67.00)];The proportion of Th cells (helper T cells) [13.50 (10.00,19.00)] and B cells [4.00 (3.00,6.00)] in the liver injury group were lower than those in the non-liver injury group [16.00 (12.00, 21.00)] and B cells [6.00 (4.00, 8.00)].There were statistically significant differences in the percentage of atypical lymphocytes, quantitative EB virus DNA, immunoglobulin (IgM) and lymphocyte subsets (proportion of Th cells, proportion of Ts cells and proportion of B cells) in 2 groups (P<0.05).There was no statistical significance in the number of immunoglobulin (IgA, IgG) and NK cells in 2 groups (P>0.05). Conclusion Liver damage is more frequently observed in IM children, with higher incidence in female children and early school age children. The percentage of abnormal lymphocytes, EB Epstein-Barr virus load and cellular immunity were correlated with liver damage in IM. Children with liver damage are prone to immune dysfunction.

Key words: Infectious mononucleosis, Liver damage, Percentage of abnormal lymphocytes, EB virus DNA quantification, Humoral immunity, Lymphocyte subsets

张懿, 朱欣欣. 传染性单核细胞增多症合并肝损伤患儿的临床特点[J]. 肝脏, 2025, 30(6): 847-849.

ZHANG Yi, ZHU Xin-xin. Clinical study of infectious mononucleosis complicated with liver damage in children[J]. Chinese Hepatolgy, 2025, 30(6): 847-849.

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