摘要
目的 探讨传染性单核细胞增多症(IM)患儿肝损害的临床特征及其与血清白细胞介素1β(IL-1β)、中性粒细胞淋巴细胞计数比值(NLR)水平的相关性.方法 回顾性选取2020年4月至2023年4月入战略支援部队特色医学中心治疗的100例原发性IM患儿作为研究对象,按照有无肝功能损害将其分为肝损害组(n=41)与无肝损害组(n=59).比较肝损害与非肝损害患儿的临床特征(性别、年龄、发热时间、体温峰值以及典型症状等)以及实验室指标[丙氨酸转移酶(ALT)、免疫球蛋白(Ig)A、IgM、IgG、CD4+/CD8+、NK、NLR、IL-1β等],统计组间差异以及NLR、IL-1β与IM患儿合并肝损害的相关性.结果 合并肝损害组与非肝损害组IM患儿的性别、发热时间、体温峰值以及咽峡炎症症状、颈部淋巴结肿胀、脾肿大、眼睑水肿比例比较,差异均无统计学意义(P＞0.05);合并肝损害组IM患儿年龄为(4.54±1.05)岁,明显高于非肝损害组[(3.32±0.99)岁],肝肿大比例为39.02％,明显高于非肝损害组(18.64％),差异均有统计学意义(P＜0.05).肝损害组IM患儿血清ALT、IgA、IgM、IgG、IL-1β水平分别为(51.01±3.13)U/L、(1.58±0.61)g/L、(1.96±0.78)g/L、(11.90±2.16)g/L、(11.27±1.98)ng/L,均明显高于非肝损害组[(28.48±3.87)U/L、(1.25±0.63)g/L、(1.64±0.48)g/L、(10.60±3.89)g/L、(8.25±1.59)ng/L],CD4+/CD8+、NLR 分别为 0.34±0.05、0.58±0.19,均明显低于非肝损害(0.59±0.15、1.43±0.16),差异均有统计学意义(P＜0.05);肝损害组与非肝损害组IM患儿的NK细胞水平比较,差异无统计学意义(P＞0.05).IM患儿血清IL-1β与肝损害呈正相关(P＜0.05),NLR与肝损害呈负相关(P＜0.05).结论 合并肝损害IM患儿肝肿大明显,且年龄偏大,需重点观察.IM患儿合并肝损害伴有细胞免疫功能异常,血清IL-1β明显升高,而NLR明显降低,可以作为判断IM患儿肝损害的关键指标.
Abstract
Objective To investigate the clinical characteristics of children with infectious mononucleosis(IM)and liver damage and its correlation with serum interleukin-1 β(IL-1 β)and neutrophil lymphocyte count ratio(NLR).Methods One hundred children with primary IM who were admitted to Strategic Support Force Specialty Medical Center from April 2020 to April 2023 were retrospectively selected as research subjects.They were divided into the liver damage group(n=41)and the non liver damage group(n=59)based on the presence or absence of liver function damage.The clinical features(gender,age,duration of fever,peak body temperature,and typical symptoms,etc)and laboratory indicators[alanine aminotransferase(ALT),immunoglobulin(Ig)A,IgM,IgG,CD4+/CD8+,NK,IL-1 β,NLR,etc]of liver damage and non-liver damage in the two groups and in the IM children were compared,and the differences between the groups and the correlation between NLR,IL-1β and liver damage in IM children were analyzed.Results There were no statistically significant differences in the gender,fever du-ration,peak body temperature,the proportion of pharyngeal inflammatory symptoms,neck lymph node swelling,splenomegaly,and eyelid edema between the combined liver damage group and the non liver damage group of IM children(P＞0.05);the age of IM children in the group with combined liver damage was(4.54±1.05)years old,which was significantly higher than that in the non liver damage group[(3.32±0.99)years old],the proportion of hepatomegaly was 39.02％,which was significantly higher than that in the non liver damage group(18.64％),and the differences were statistically significant(P＜0.05).The levels of serum ALT,IgA,IgM,IgG,IL-1 β in the liver damage group of IM children were(51.01±3.13)U/L,(1.58±0.61)g/L,(1.96±0.78)g/L,(11.90±2.16)g/L,and(11.27±1.98)ng/L,respectively,which were significantly higher than those in the non liver damage group[(28.48±3.87)U/L,(1.25±0.63)g/L,(1.64±0.48)g/L,(10.60±3.89)g/L,(8.25±1.59)ng/L],the CD4+/CD8+and NLR were 0.34±0.05 and 0.58±0.19,respectively,which were significantly lower than those in the non liver damage group(0.59±0.19,1.43±0.16),the differences were statistically significant(P＜0.05);there was no statistically significant difference in the NK cell levels between the liver damage group and the non liver damage group of IM children(P＞0.05).Serum IL-1 β was positively correlated with liver damage in IM children(P＜0.05),while NLR was negatively correlated with liver damage(P＜0.05).Conclusion Hepatomegaly is obvious and older in children with IM complicated with liver damage,which needs to be carefully ob-served.In children with IM complicated with liver damage,cellular immune function is abnormal,serum IL-1 β is significantly increased and NLR is significantly decreased,which can be used as a key indicator to determine liver damage in children.
基金项目
北京市卫生健康委科研项目(BJWJ2022b008)
维普
万方数据