| Objective: Objective to investigate the clinical characteristics of infectious mononucleosis in children and analyze the risk factors of IM with liver damage,so as to provide the basis for the early prevention and treatment of IM and Im with liver damage.Methods:The clinical data of 109 im patients were analyzed retrospectively.According to the age of the children,they were divided into three groups: ≤3 years old,3~7 years old and > 7 years old.The epidemiological characteristics,clinical manifestations,laboratory indexes,complications,treatment and risk factors of liver injury were analyzed by spss26.0 software.Results: 1.Epidemiological characteristics:Time distribution: the incidence of 2015~2020 years was 8 cases,16 cases,17 cases,21 cases,29 cases,18 cases.The incidence rate was four cases in the four seasons:22.9% cases in spring,22.9% cases in summer,autumn in winter cases,and winter cases.Population distribution: Among 109 cases,there were 66 males and 43 females,the ratio of male to female was 1.5:1,the median age was 4.5 years old,the minimum age was 6 months,the maximum age was 14 years old,common in 3~7 years old children,accounting for 52.3%,followed by ≤3 years old group and > 7 years old group,accounting for 29.4% and 18.3% respectively;Nationality: among 109 cases,there were 77 cases of Han nationality,29 cases of Tujia nationality and 3 cases of Miao nationality.Regional distribution: 64 cases in Enshi City,44 cases in other counties and cities in Enshi Prefecture,and 1 case in other provinces.2.Clinical manifestations: fever(97 cases,accounting for 89.0%),lymphadenopathy(102 cases,accounting for 93.6%),angina(77 cases,accounting for 70.6%),eyelid edema(51cases,accounting for 46.7%)were the main clinical symptoms of 109 cases,followed by cough(37 cases,accounting for 33.9%),splenomegaly(34 cases,accounting for31.1%),hepatomegaly(33 cases,accounting for 30.2%),snoring at night(31 cases,accounting for 28.4%),nasal obstruction(28 cases,accounting for 25.7%),rash(9cases,accounting for 8.3%)and headache(2cases,accounting for 1.8%)were rare;the incidence and maximum diameter of cervical lymph node enlargement in 3~7years old group were greater than those in ≤ 3 years old group(P<0.05),and other clinical manifestations were not statistically significant.3.Laboratory indexes: WBC,LY and ALY of ≤ 3 years old group and 3~7 years old group were higher than those of > 7 years old group(P<0.05),ALT and GGT of 3~7 years old group and > 7 years old group were higher than those of ≤ 3 years old group(P<0.05),CD4+ value of ≤ 3years old group was higher than that of > 7 years old group(P<0.05),CD8+ value of >7 years old group was higher than that of ≤3 years old group and 3~7 years old group(P<0.05),and ferritin of > 7 years old group was higher than that of ≤ 3 years old group and 3~7 years old group(P<0.05)The other laboratory indexes were not statistically significant.4.Complications: Among 109 cases,57 cases(52.3%)had liver injury,29 cases(26.6%)had anemia,14 cases(12.8%)had neutropenia,13 cases(11.9%)had myocardial damage,8 cases(7.3%)had transient proteinuria,7 cases(6.4%)had thrombocytopenia,4 cases(3.7%)had transient hematuria,3 cases(2.8%)had neutropenia,3 cases(2.8%)had pulmonary infection,2 cases(1.8%)had hemophagocytic syndrome,2 cases(1.8%)had febrile shock 1 cases(0.9%),1 cases(0.9%)of sinus tachycardia,and the incidence rate of anemia in group 3 and 3 years old was higher than that in 3~7 years old group and 7 year old group(P<0.01).5.Age was the risk factor of im with liver damage(OR= 1.230,95% IC [1.039-1.455])(P<0.05).The older the age,the more prone to liver damage.According to 40 < ALT and(or)AST≤ 80,80 < ALT and(or)AST≤ 200,200 < ALT and(or)AST,the children with severe liver damage were divided into three groups.The serum EBV-DNA load of children with severe liver damage was higher than that of children with mild liver damage(P<0.05).Conclusion: 1.The incidence of im in local children all year round,especially in summer and autumn,male more than female,Han more than minority,common in preschool children;2.The most common clinical manifestations of im in children were fever,cervical lymphadenopathy,angina and eyelid edema;3.WBC,LY,ALY,CD4+ of infants were higher than that of older children,and alt,GGT,ferritin and CD8+ were higher in older children,and alt,GGT,ferritin and CD8+ increased with age;4.The most common complication of IM in children is liver injury,and the most serious complication is hemophagocytic syndrome.The incidence of anemia decreases gradually with age,and the prognosis is fair.5.Older age may be an independent risk factor for liver injury in children with IM,the more EBV-DNA replication is,the more likely it is to increase the degree of liver injury. |
PDF Full Text Request