【作者】 王爽；

【导师】 贾蓓；

【作者基本信息】 重庆医科大学 ， 内科学（传染病学）， 2016， 硕士

【摘要】 目的:分析我院感染科近4年来收治的临床诊断的成人传染性单核细胞增多症(Infectious Mononucleosis,IM)的症状、体征、实验室检查的特点,提高对该病的认识。方法:收集重庆医科大学附属第一院感染科在2012年1月~2015年12月期间符合EBV感染诊断标准的91例患者的临床数据,并对其进行回顾性分析。分析指标包括患者基本信息、发病时间、症状、体征、血液检查中淋巴细胞比例及异型淋巴细胞比例、肝功,影像学检查中胸部摄片、腹部B超等。结果:本组患者共有91例,16~25岁有53例(58.2%),男性47例(51.6%),女性46例(48.4%),夏季(6~8月)发病35例(38.5%),临床症状以三联征最常见,包括发热86例(94.5%)、咽峡炎69例(75.8%)、颈部淋巴结肿大76例(83.5%),此外,脾脏肿大55例(60.4%),皮疹17例(29.7%),肝脏肿大者5例(5.5%)。实验室检查:白细胞计数(white blood cell count,WBC)>10*109/L的患者有59例(64.8%),淋巴细胞百分比>35%的患者有83例(91.2%)例,>50%者有64例(70.2%),异型淋巴细胞百分比>10%的患者数目为76,占83.5%,转氨酶异常的病例数为83,占91.2%,高达96.7%的病人乳酸脱氢酶(lactate dehydrogenase,LDH)升高,EB病毒衣壳抗原IgM抗体(Epstein-Barr virus Virus Capsid Antigen IgM,EBV-VCA-IgM)的阳性率为71.4%。治疗上予以抗病毒及对症支持,大多预后良好,仅有一例重症病例,发展为及吉雷-巴特综合征(Guillain-Barre Syndrome,GBS)。结论:成人IM患者的症状和阳性体征及实验室检查结果较为多样,临床医生应加深对IM临床特点的认识,以降低误诊率和漏诊率,防治并发症。更多还原

【Abstract】 Objective:To analyze the clinical manifestations and laboratory examinations of that diagnosed infectious mononucleosis(IM)and collected in Infectious Diseases department of The Affiliated Hospital of Chongqing Medical University for improving its clinical diagnosis and treatment.Methods: The clinical analysis of 91 cases with IM admitted to our department from January 2012 to December 2015 were summarized retrospectively,including age,gender,identity,the clinical symptoms,signs,laboratory examinations,images and so on.Results: In the 91 cases,47 male cases and 46 female cases,53 cases aged between 16 and 25 years old accounting for 76.9%.It showed that the disease was a pattern with a peak incidence during summer months35(38.5%) cases.Most frequent clinical symptoms were fever(94.5%),isthmitis(75.8%)and cervical lymphadenopathy(83.5%).We found the prevalence of splenomegaly(60.4%),rashes(29.7%) and hepatomegaly(5.5%).The laboratory examinations showed that 64.8% of IM patients had white blood cell count(WBC)more than 10×109/L;91.2%of these patientshad increased lymphocyte rates more than 35% and 70.2% of cases was more than 50%;83.5% of these patients had atypical lymphocyte rates more than 10%;89.7% of cases had liver function damages along with increasing Alanineamino Transferase(ALT) and Aspartateamino Transferase(AST)levels; 96.7% of these patients had abnormal lactate dehydrogenase(LDH)enzymes and 71.4% of them had positive Epstein-Barr virus virus capsid antigen antibody(EBV-VCA-lgM).All of the patients were recovered completely except one severe case developing to Guillan-Barre syndrome.Conclusions: The clinical manifestations and examinations of adult cases were varied.The chances of misdiagnosis and missed diagnosis could be decreased via better understanding of the diverse clinical features in adult patients with IM.更多还原