成人传染性单核细胞增多症39例临床特点分析
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Clinical features of adult patients with infectious mononucleosis
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    目的:分析传染性单核细胞增多症(infectious mononucleosis,IM)成人患者的临床表现及实验室检查结果,以提高临床诊疗水平。方法:收集2011年4月至2013年8月我科收治的39例成人IM患者的临床资料进行回顾性分析。结果:本组患者16~30岁28例(71.8%),大多预后良好,有1例重症病例,发展为格林巴利综合征。临床症状以三联征包括发热(82.1%)、咽峡炎(76.9%)、颈淋巴结肿大(74.4%)最常见,脾脏肿大占46.2%,皮疹占41.0%,肝脏肿大者占2.5%,有合并甲状腺功能亢进症(Graves’ dsease,Graves’病)及其他病毒感染。实验室检查:26例白细胞(white blood cell,WBC)计数>10×109个/L(66.7%),淋巴细胞比例>35%的患者有34例(87.2%),>50%的有28例(72%),异型淋巴细胞比例>10%者占84.6%,转氨酶升高者占89.7%,所有病人的乳酸脱氢酶(lactate dehydrogenase,LDH)均升高,EB病毒(Epstein-Barr virus,EBV)的IgM抗体阳性率69.2%。结论:成人IM临床表现与实验室检查结果较为多样,临床医生应提高对本病临床特点的认识,以减少误诊和漏诊。

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    Objective:To investigate the clinical manifestation and laboratory examination results of infectious mononucleosis(IM) and to improve its clinical diagnosis level. Methods:Clinical data of 39 patients with IM admitted to our department from April 2011 to August 2013 were analyzed retrospectively. Results:Patients aged between 16 and 30 years old accounted for 71.8%. All patients were recovered completely except one severe case developing to Guillan Barre syndrome. Most common clinical symptoms included fever(82.1%),isthmitis(76.9%) and cervical lymphadenopathy(74.4%). Besides,incidences of splenomegaly,rashes and hepatomegaly were 46.2%,41.0% and 2.5%,respectively. Cases complicated with Graves’ disease or other virus infections were found. Laboratory examination results showed that 66.7% IM patients had white blood cell count more than 10×109/L;87.2% had increased lympho-cyte ratio more than 35% and 72% more than 50%;84.6% had atypical lymphocyte ratio more than 10%;89.7% had liver function damages with increased alanine aminotransferase and aspartate aminotransferase levels. All patients had abnormal lactate dehydroge-nase enzymes and 69.2% had positive Epstein-Barr virus virus capsid antigen antibody(EBV-VCA-IgM antibody). Conclusion:Chances of misdiagnosis and missed diagnosis could be decreased via better understanding of the diverse clinical features in adult patients with IM.

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王 爽,熊域皎,刘彦伶,贾 蓓,黄文祥.成人传染性单核细胞增多症39例临床特点分析[J].重庆医科大学学报,2014,38(12):1822-1824

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  • 在线发布日期: 2015-11-06
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