摘要目的 探讨儿童传染性单核细胞增多症(IM)的临床特点及其与急性化脓性扁桃体炎的鉴别要点,避免误诊、误治.方法 选择2015年1月至2017年12月解放军联勤保障部队第九二四医院儿科收治的IM患儿49例(儿童IM组)和急性化脓性扁桃体炎患儿228例(儿童急性化脓性扁桃体炎组)为研究对象,回顾性分析两组患儿的临床资料.结果 IM占同期住院患儿的0.91％(49/5400),化脓性扁桃体炎患儿占同期住院患儿的4.22％(228/5400).两组发病年龄比较差异未见统计学意义(P>0.05),发热天数比较差异有统计学意义(P<0.05).两组白细胞计数比较差异未见统计学意义(P>0.05);儿童IM组外周血淋巴细胞比例、淋巴细胞计数、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶均高于儿童急性化脓性扁桃体炎组(P均<0.05);儿童急性化脓性扁桃体炎组C反应蛋白(CRP)水平高于儿童IM组,差异有统计学意义(P<0.01).结论 发热、颈淋巴结肿大和扁桃体炎三联症是IM的典型临床表现,对发热伴扁桃体炎特别有扁桃体白色渗出的患儿,临床需重视外周血淋巴细胞比例、淋巴细胞计数和CRP、肝功能结果检查,避免IM的漏诊及误诊、误治.

abstractsObjective To investigate the clinical features of infectious mononucleosis (IM)in children,especially the key points of differential diagnosis between it and acute purulent tonsillitis,in order to avoid misdiagnosis and wrong treatment.Methods Forty-nine IMchildren and 228 suppurative tonsillitis children treated in the 924 Joint Service Support Force of the Chinese People's Liberation Army Hospital from January 2015 to December 2017 were allocated into IM group and suppurative tonsillitis group,respectively.A retrospective analysis was performed on the clinical data from the two groups. Results IMaccounted for 0.91％(49/5400)of hospitalized children in the same period,and the proportion of patients with suppurative tonsillitis was 4. 22％(228/5400).However,the difference in fever days was significant between the two groups (P<0. 05 ).There was no significant difference in white blood cell count between the two groups (P>0. 05 );on the contrary,there were significant differences in lymphocyte ratio,lymphocyte count,alanine aminotransferase and aspertate aminotransferase levels between the two groups (P<0. 05 ).The level of C-reactive protein in the suppurative tonsillitis group was higher than that in the IM group (P<0.05).Conclusions Fever,cervical lymph node enlargement and tonsillitis are the typical clinical manifestations of IM.For tonsillitis children with fever and white pus, lymphocyte ratio and lymphocyte count,especially,the C-reactive protein and detection results of liver function should be paid more attention so as to avoid misdiagnosis and wrong treatments.