摘要
目的探讨3岁以下儿童原发性EB病毒（EBV）感染的临床表现，以提高对3岁以下儿童原发性EBV感染的认识。方法对2008年1月至2015年12月首都医科大学附属北京儿童医院收治的3岁以下血清学确诊为原发性EBV感染的597例患儿临床资料进行回顾性分析。结果共597例，年龄〈1岁83例（13．9％），1～3岁514例（86．1％）。临床表现为发热554例（92．8％）、颈部淋巴结大402例（67．3％）、肝大357例（59．8％）、肝损害266例（44．6％）、脾大195例（32．7％）、眼睑水肿173例（29．0％）、合并肺炎161例（27．0％）、皮疹158例（26．5％）。370例（62．0％）具有典型传染性单核细胞增多症（IM）样症状。合并噬血细胞综合征40例（6．7％），从起病到出现噬血细胞综合征的时间为（15．3±9．5）d。合并黄胆性肝炎6例（1．0％）、合并化脓性淋巴结炎6例（1．0％）、合并川崎病4例（0．7％）、合并脑炎或脑膜炎11例（1．8％）。1～3岁幼儿眼睑水肿、鼻塞、扁桃体分泌物、颈部淋巴结大的发生率高于年龄〈1岁婴儿（P均〈0．05）；年龄〈1岁婴儿皮疹、肺炎、心肌损害的发生率高于1～3岁幼儿（P均〈0．05）。年龄〈1岁婴儿与1～3岁幼儿在发热、肝大、脾大、血小板降低及噬血细胞综合征的发生率比较差异无统计学意义（P均〉0．05）。病史中应用头孢类抗生素285例患儿中87例（30．5％）发生皮疹，未应用抗生素的312例患儿中仅有71例（22．8％）发生皮疹，二者皮疹发生率比较差异有统计学意义（P〈0．05）。结论3岁以下儿童原发性EBV感染最常见的症状为发热、颈部淋巴结大、肝大。1～3岁幼儿发生IM的比例高于年龄〈1岁幼儿，同时更易出现肝功损害；年龄〈1岁婴儿更易出现皮疹、合并肺炎及心肌损害。婴幼儿原发性EBV感染者府慎用头袍类杭生素。
Objective To investigate the clinical characteristics of primary Epstein - Barr virus （EBV） infection in children younger than 3 years old, and to achieve deeper understanding of this disease. Methods Five hundred and ninety - seven children younger than 3 years old who had serology evidence for primary EBV infection from January 2008 to December 2015 admitted in Beijing Children＇s Hospital, Capital Medical University, were studied retrospectively. Results Among 597 patients, 83 patients （ 13.9% ） were younger than 1 year old and the other 514 patients （86.1%） were within the range of 1 -3 years old. The symptoms included fever（92.8% ,554/597 cases） , cervical lymphnode enlargement （ 67.3 % , 402/597 cases ） , hepatomegaly （ 59.8 % , 357/597 cases ） , liver damage （ 44.6 % , 266/597 cases ） , splenomegaly （ 32.7 % , 195/597 eases ） , eyelid edema （ 29.0% , 173/597 eases ） , pneumonia （ 27.0% , 161/597 cases）, and rash （ 26.5 % , 158/597 eases）. Diagnosis of infectious mononucleosis （IM） was made in 370 patients （62.0%）. Forty patients （6.7%） suffered from hemophagocytic syndrome. Duration between onset and hemo- phagocytic syndrome was （ 15.3± 9.5） days. Six patients （ 1.0% ） complicated with cholestatie hepatitis76 patients （ 1.0% ） with purulent lymphadenitis,4 patients （0.7%） with Kawasaki disease, and 11 patients （ 1.8% ） with encephalitis or meningitis. Compared with infants younger than 1 year old, the incidence of eyelid edema, nasal congestion and tonsil seeretions were more common in toddlers ranging from 1 - 3 years old （ all P 〈 0. 05 ） ; meanwhile, myocardial damage, pneumonia and rash were more common in infants （ all P 〈 0.05 ）. There was no significant difference in the incidence of fever, hepatomegaly, splenomegaly and hemophagocytic syndrome between the infants and the toddlers （ all P 〉 0.05 ）. Eighty - seven eases （ 30.5% ） of 285 patients using cephalosporin antibiotics had rash, only 71 cases （22.8%） of 312 patients did not use antibiotics with rash, there was a statistical significance in the incidence （P 〈 0. 05 ） . Conclusions Fever, cervical lymph node enlargement and hepatomegaly are the most common clinical manifestations in primary EBV infection in children younger than 3 years old. Toddlers ranging from 1 - 3 years old are more likely to have with typical IM symptom and elevated ALT than infants; meanwhile, rash, pneumonia and myocardial damage are more common in infants. Cephalosporin should be used with caution in children younger than 3 years old with primary EBV infection.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2016年第22期1700-1704,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
北京市卫生系统高层次卫生人才基金（2011-3-035）
关键词
EB病毒
原发性EB病毒感染
儿童
Epstein - Barr virus
Primary Epstein - Barr virus infection
Child
