摘要
目的总结儿童传染性单核细胞增多症(IM)合并肝损害的发生率及临床相关因素,提高对肝损害的认识与防治水平。方法回顾性分析106例IM患儿的临床资料及并发肝损害情况,分析不同性别、年龄、主要临床表现、实验室检查等指标与并发肝损害的关系。结果 IM肝损害发生率为53.8%;不同年龄组的并发肝损害情况有显著差异(x^2=10.46,P<0.01),年龄越大并发肝损害概率越大;IM发热持续时间>1周、肝脏肿大、脾脏肿大与并发肝损害均相关(x^2值分别为9.40、9.19、4.86,均P<0.05);IM外周血小板<100×10~9/L或异常淋巴细胞数≥20%与并发肝损害均相关(x^2值分别为5.89、4.85,均P<0.05),血小板减少和异常淋巴细胞数增多越明显并发肝损害的概率越高;IM合并肝损害组较无肝损害组CD4^+数明显减少,而CD8^+数明显增多,CD4^+/CD8^+比值明显降低,差异均有统计学意义(t值分别为2.369、2.526、2.968,均P<0.05)。对相关因素进一步行多因素非条件Logistic回归分析显示:持续发热>1周、CD8^+高为IM并发肝损害的独立危险因素(OR值分别为2.67、1.48,均P<0.05)。结论儿童IM肝功能损害与患儿年龄、发热时间、肝脾肿大及外周血异常淋巴细胞、血小板减少、T淋巴细胞亚群等具有相关性;持续发热>1周,CD8^+高为IM并发肝损害的独立危险因素。对肝功能损害患儿应加强其早期护肝及免疫调节治疗。
Objective To summarize the incidence and clinical relevant factors of infectious mononucleosis （ IM） in children combined with liver damage and to raise the level of understanding and prevention of liver damage.Methods The clinical data and concurrent liver damage of 106 cases of children with IM were reviewed retrospectively.The relationship between gender, age, main clinical manifestations, laboratory examination indexes and concurrent liver damage was analyzed.Results The incidence of liver damage in IM was 53.8%.There was significant difference in concurrent liver damage among cases of different age （χ^2 =10.46,P〈0.01）.When the cases were older, the probability of liver damage was greater.Liver damage was correlated with persistent fever longer than one week because of IM, hepatomegaly and splenomegaly （χ^2 value was 9.40, 9.19 and 4.86, respectively, all P〈0.05）.Meanwhile, platelet （〈100 ×10^9/L） and abnormal lymphocyte count （≥20%） were correlated with liver damage （χ^2 value was 5.89 and 4.85, respectively, both P〈0.05） . The more obvious thrombocytopenia and abnormal lymphocyte number increasing, the higher probability of concurrent liver damage. Compared with the group without liver damage, the number of CD4 ^＋cell and the ratio of CD4 ^＋/CD8^ ＋decreased significantly, and the number of CD8 ^＋cell increased obviously in the group with liver damage （ t value was 2.369, 2.526 and 2.968, respectively, all P〈0.05）.Multivariate unconditional Logistic regression analysis showed that persistent fever longer than one week and increased CD8 ^＋cell were the independent risk factors of concurrent liver damage （OR value was 2.67 and 1.48, respectively, both P〈0.05）.Conclusion Liver damage in children with IM is correlated with age, duration of fever, hepatosplenomegaly, abnormal lymphocyte of peripheral blood, thrombocytopenia and T lymphocyte subgroup.Persistent fever longer than one week and increased CD8^ ＋cell are the independent risk factors of concurrent liver damage.Early protection and immunoregulation therapy should be strengthened for children with liver damage.
出处
《中国妇幼健康研究》
2015年第2期274-276,共3页
Chinese Journal of Woman and Child Health Research
关键词
儿童
传染性单核细胞增多症
肝功能损害
相关因素
children
infectious mononucleosis （IM）
liver function damage
relevant factors
