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目的 了解成人传染性单核细胞增多症(IM)患者的临床表现及实验室特点,提高对该病的认识.方法 回顾性分析2015年6月至2017年12月在山西医科大学第一医院住院治疗的48例成人IM患者的临床特征和实验室检查结果.结果 成人IM呈全年散发,男性多于女性(2.2:1),患者平均年龄31.0岁,其中18～25岁19例(39.6％),26～33岁17例(35.4％).48例IM患者均有发热表现(100.0％),其次为脾大(36例,75.0％)和咽峡炎(34例,70.8％),淋巴结肿大(21例,43.8％)和头晕头痛(21例,43.8％).病毒定量阳性率为68.1％(32/47),Epstein-Barr病毒(EBV)CA-IgM阳性率51.7％(15/29),EBEA IgM阳性率34.5％(10/29).19例(39.6％)出现WBC异常,23例(47.9％)淋巴细胞百分比>50％,27例(56.3％)单核细胞百分比>10％,8例(16.7％)血小板减少,40例(83.3％)肝酶升高,可伴碱性磷酸酶(ALP)、γ-谷氨酰转移酶(γ-GT)、总胆红素增高.所有患者肾功能及凝血系列未见明显异常.经抗病毒及对症支持治疗后,46例好转,2例发展为嗜血细胞综合征.结论 成人IM全年散发,中青年人群好发,临床表现常不典型,大部分预后良好,少数患者出现严重并发症,预后差.

Objective To observe the clinical manifestations and laboratory characteristics of infectious mononucleosis (IM) in adults, and to improve the understanding of the disease. Methods The clinical data of 48 adult patients with IM, who were hospitalized in the First Hospital of Shanxi Medical University from June 2015 to December 2017, were retrospectively analyzed. Results The incidence of IM in adults was distributed throughout the year. The average age of the patients was 31.0 years old, and there were more males than females(2.2 : 1). There were 19 cases (39.6％) between 18 and 25 years old, and 17 cases (35.4％) between 26 and 33 years old. Main clinical symptoms were fever(100.0％, 48 cases), splenomegaly(75.0％, 36 cases), angina (70.8％, 34 cases), lymph node enlargement(43.8％, 21 cases) and dizziness headache(43.8％, 21 cases ). The positive rates of viral load, Epstein-Barr virus (EBV) CA-IgM and EBEA IgM were 68.1％ (32/47), 51.7％ (15/29) and 34.5％(10/29), respectively. Nineteen cases (39.6％) had abnormal WBC, 23 cases (47.9％ ) had lymphocyte percentage > 50％ , 27 cases (56.3％) had mononuclear cell percentage > 10％, 8 cases(16.7％) had platelet reduced, and 40 cases (83.3％) had liver enzyme increased with ALP, γ-GT and total bilirubin increased. No significant abnormalities were found in renal function and blood coagulation in all patients. After antiviral therapy and symptomatic support, 46 patients improved and 2 developed into hemophagocytic syndrome. Conclusions The incidence rate of adult infectious mononucleosis is increasing in recent years with predilection of young and medal aged population, and the clinical manifestations are complicated and varied. Most of the patients have good prognosis, and a few patients have serious complications and poor prognosis.