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目的探讨伴有多脏器功能损害的传染性单核细胞增多症(传单)的临床特征,总结重症传单的诊断要点。方法回顾性分析重庆医科大学附属儿童医院2003-01—2006-08间51例伴多脏器功能损害传单病例的临床资料,并与602例无多脏器功能损害传单的临床资料比较。结果与无多脏器功能损害传单患儿比较,51例伴多脏器功能损害传单患儿的发热持续时间长,肝脾肿大程度重,而咽峡炎和淋巴结肿大发生率低;伴多脏器功能损害传单患儿外周血2系或3系减少者明显高于无多脏器功能损害传单患儿(92.2%对9.1%,P<0.001),其外周血异形淋巴细胞比例≥10%者占47.1%;伴多脏器功能损害传单患儿的肝功能损害显著重于无多脏器功能损害传单患儿,转氨酶、直接胆红素和乳酸脱氢酶(LDH)显著增高,并有54%的患儿LDH超过16.7μmol/(s.L);低蛋白血症(58%)、黄疸(54%)、浆膜腔积液(54.9%)和消化道出血(35.3%)更常见于伴多脏器功能损害传单。51例伴多脏器功能损害传单患儿预后不同,其中29.4%的患儿死亡或放弃治疗,49%的患儿好转。结论伴多脏器功能损害传单即重症传单的诊断要点:持续发热,肝脾明显肿大;外周血象呈2系或3系减少;肝脏转氨酶异常明显,LDH显著增高;同时合并黄疸、低蛋白血症和浆膜腔积液甚至消化道出血等。重症传单和噬血淋巴组织细胞增生症可能本质相似。
Objective To investigate the clinical features of infectious mononucleosis (leaflet) accompanied by multiple organ dysfunction and summarize the main points of diagnosis of severe leaflets. Methods The clinical data of 51 cases with multiple organ dysfunction leaflets from 2003-01 to 2006-08 in Children’s Hospital of Chongqing Medical University were retrospectively analyzed and compared with the clinical data of 602 cases without functional organ failure. Results Compared with children without multiple organ dysfunction leaflets, 51 patients with multi-organ dysfunction leaflets had long duration of fever, severe hepatosplenomegaly and low incidence of angina and lymphadenopathy. The number of peripheral blood mononuclear cells in children with multiple organ dysfunction syndrome was significantly higher than that in children without multiple organ dysfunction syndrome (92.2% vs 9.1%, P <0.001), and the proportion of peripheral blood lymphocytes was ≥10 % Of them accounted for 47.1%; children with multiple organ dysfunction leaflets were significantly more likely to suffer liver damage than those without multiple organ dysfunction leaflets, and aminotransferases, direct bilirubin and lactate dehydrogenase (LDH) were significantly increased LDH more than 16.7 μmol / (sL) occurred in 54% of children; hypoproteinemia (58%), jaundice (54%), serous effusions (54.9%) and gastrointestinal bleeding (35.3% With multiple organ damage to leaflets. 51 cases with multiple organ dysfunction flyers with different prognosis, 29.4% of children died or give up treatment, 49% of children improved. Conclusions The diagnosis of multiple organ dysfunction leaflets or severe flyers: continuous fever, liver and spleen were significantly enlarged; peripheral blood showed 2 or 3 lines decreased significantly abnormal hepatic transaminases, LDH was significantly higher; combined with jaundice, low protein blood Symptoms and serosal effusion and even gastrointestinal bleeding. Severe leaflets and hemophagocytic lymphohistiocytosis may be similar in nature.