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目的观察多重病原体感染的传染性单核细胞增多症(IM)患儿白细胞(WBC)计数、异常淋巴细胞(异淋)和肝酶的变化。方法分析170例初诊IM患儿EB病毒、巨细胞病毒、单纯疱疹病毒、风疹病毒和弓形虫IgM抗体阳性分布情况,观察IM患儿外周血WBC、异形淋巴细胞和血清肝酶水平的变化。结果 170例IM患儿,9例未检出病原体IgM抗体,30例检出1种病原体IgM抗体,74例检出2种病原体IgM抗体,49例检出3种病原体IgM抗体,8例检出4种病原体IgM抗体,以EB病毒、巨细胞病毒和单纯疱疹病毒IgM抗体阳性为主。IM患儿丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、WBC计数和异形淋巴细胞均明显高于健康对照组,差异有统计学意义(P均<0.01)。IM患儿A、B、C、D、E各组间两两比较,B、C、D、E组的ALT、AST、WBC计数和异形淋巴细胞均明显高于A组,差异有统计学意义(P均<0.05);B、C、D和E组之间的ALT、AST、WBC计数和异形淋巴细胞均无明显差异(P均>0.05)。结论 IM以多重感染为主,尤其是EB病毒与巨细胞病毒、单纯疱疹病毒的多重感染,多种病原体抗体联合检测可有效提高IM检出率和准确性,防止漏诊、误诊。IM患儿WBC计数、异形淋巴细胞和肝酶明显升高,升高的幅度与病原体IgM抗体的有无有关而与种类多少无关。应重视IM患儿的实验室检查以辅助诊断和指导治疗。
Objective To observe the changes of white blood cell (WBC) counts, abnormal lymphocytes (abnormal lymphocytes) and liver enzymes in children with infectious mononucleosis (IM) infected by multiple pathogens. Methods The positive distribution of Epstein - Barr virus, cytomegalovirus, herpes simplex virus, rubella virus and toxoplasma gondii in 170 infants with newly diagnosed IM were analyzed. The changes of peripheral blood WBC, atypical lymphocytes and serum liver enzymes in IM children were observed. Results Among 170 cases of IM, 9 cases did not detect pathogen IgM antibody, 30 cases detected one kind of pathogen IgM antibody, 74 cases detected two kinds of pathogen IgM antibody, 49 cases detected three kinds of pathogen IgM antibody, 8 cases detected Four kinds of pathogen IgM antibodies, with Epstein-Barr virus, cytomegalovirus and herpes simplex virus IgM antibody-based. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), WBC count and abnormal lymphocytes in IM patients were significantly higher than those in healthy controls (P <0.01). The ALT, AST, WBC counts and abnormal lymphocytes in groups B, C, D and E were significantly higher than those in group A, with significant difference between group A, B, C, D and E (P <0.05). There was no significant difference in ALT, AST, WBC count and abnormal lymphocytes between groups B, C, D and E (all P> 0.05). Conclusion Multiple infections are the mainstay of IM. In particular, multiple infections of Epstein-Barr virus and cytomegalovirus (CMV) and herpes simplex virus (HSV), combined detection of multiple pathogens and antibodies, can effectively improve the detection rate and accuracy of IM, preventing misdiagnosis and misdiagnosis. WBC counts, abnormal lymphocytes and liver enzymes in IM children were significantly increased, the magnitude of the increase with the presence or absence of pathogen IgM antibodies has nothing to do with the number of species. Should pay attention to the laboratory tests of IM children to help diagnose and guide treatment.