儿童急性布鲁菌病伴转氨酶异常临床特征分析

doi:10.12372/jcp.2024.23e0662

摘要/Abstract

摘要：

目的探讨急性布鲁菌病患儿伴转氨酶异常的临床特征。方法选取2015年1月至2021年12月住院诊断为急性布鲁菌病的43例患儿为研究对象，根据患儿血清学转氨酶结果分为转氨酶异常组和转氨酶正常组，对两组临床表现及实验室指标异同进行分析。结果 74.41 %（33/43）的患者合并转氨酶异常且以轻中度异常为主。转氨酶异常组肝脾肿大的发生率高于转氨酶正常组（P<0.05）。转氨酶异常组外周血血红蛋白、血小板计数均低于转氨酶正常组，而血培养阳性率高于转氨酶正常组（P<0.05）。转氨酶异常组外周血CD3⁺CD4^-CD8^-T细胞百分比高于转氨酶正常组(P<0.05)且CD3⁺CD4^-CD8^-T细胞百分比与ALT、AST数值呈显著正相关（r=0.601、0.466）。轻度转氨酶异常患儿转氨酶恢复时间为1~3周，中重度为3~6周。结论儿童急性布鲁菌病合并转氨酶异常比例较高，以轻中度异常为主，预后较好。CD3⁺CD4^-CD8^-T细胞百分比可能与儿童布鲁氏菌病转氨酶异常相关。

关键词: 急性布鲁菌病, 转氨酶异常, 双阴性T细胞, 儿童

Abstract:

Objective The purpose of this study was to investigate the clinical characteristics of acute brucellosis with abnormal transaminase in children. Methods The data of 43 patients diagnosed with brucellosis from January 2015 to December 2021 were analyzed retrospectively. Based on transaminase values, the patients were divided into 2 groups: abnormal transaminase group and normal transaminase group. The clinical manifestations and laboratory indexes of two groups were analyzed. Result Abnormal transaminase was found in 74.41% of study group and mainly consist of mild and moderate abnormalities. The proportion of splenomegaly in abnormal transaminase group was higher than that in normal transaminase group (P<0.05). In the patients who had abnormal transaminase, the hemoglobin and platelet values were lower, and the blood culture positive rate were higher (P<0.05). The proportion of CD3⁺CD4^-CD8^-T cells was significantly higher than that of normal transaminase group (P<0.05) and the percentage of CD3⁺CD4^-CD8^-T cells was positively correlated with ALT and AST values (r=0.601, 0.466). The recovery time of transaminase was 1-3 weeks for mild abnormal transaminase, and 3-6 weeks for moderate and severe abnormal transaminase. Conclusion The proportion of children with acute brucellosis complicated with abnormal transaminase is higher, with mild and moderate abnormalities being predominant. Acute brucellosis complicated with abnormal transaminase in children has a favorable prognosis. Percentage of CD3⁺CD4^-CD8^-T cells may be related to abnormal transaminase in children with acute brucellosis.

Key words: acute brucellosis, abnormal transaminase, double negative T cells, child

贾艳红, 郭芳, 武晓园, 贾莉, 赵欣, 李文辉. 儿童急性布鲁菌病伴转氨酶异常临床特征分析[J]. 临床儿科杂志, 2024, 42(11): 907-911.

JIA Yanhong, GUO Fang, WU Xiaoyuan, JIA Li, ZHAO Xin, LI Wenhui. Characteristic analysis of acute brucellosis in children with abnormal transaminase[J]. Journal of Clinical Pediatrics, 2024, 42(11): 907-911.

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组别	转氨酶异常组(n=32)	转氨酶正常组(n=11)	统计量	P
性别（男/女）	22/10	6/5	χ²=0.24	0.627
年龄[M(P₂₅~P₇₅)]/岁	6.0（4.0~10.5）	9.0（5.0~12.0）	Z=1.11	0.268
发热[n(%)]	31（96.87）	11（100）	χ²=0.00	1.000
关节痛（有/无）	5/27	1/10	χ²=0.00	0.972
肝肿大（是/否）	14/18	2/9	χ²=1.33	0.249
脾肿大（是/否）	22/10	3/8	χ²=4.21	0.040
入院前时间[M(P₂₅~P₇₅)]/d	12.0（7.0~20.0）	15.0（10.0~30.0）	Z=0.99	0.321
住院时间[M(P₂₅~P₇₅)]/d	12.0（9.3~15.8）	11.0（9.0~16.0）	Z=0.27	0.791

项目	转氨酶异常组（n=32）	转氨酶正常组（n=11）	统计量	P
WBC[M(P₂₅~P₇₅)]/×10⁹·L^-1	6.65（5.02~7.87）	6.5（4.90~8.90）	Z=0.36	0.717
HGB[M(P₂₅~P₇₅)]/g·L^-1	113（105.25~121.00）	120（116.00~125.00）	Z=2.40	0.017
PLT[M(P₂₅~P₇₅)]/×10⁹·L^-1	187.34±82.21	281.54±80.58	t=3.29	0.002
TB[M(P₂₅~P₇₅)]/μmol·L^-1	5.35（3.70~6.70）	6.00（4.00~7.80）	Z=0.38	0.707
PD[M(P₂₅~P₇₅)]/μmol·L^-1	2.35（1.90~4.00）	2.60（2.00~3.20）	Z=0.14	0.889
GGT[M(P₂₅~P₇₅)]/U·L^-1	27.50（14.50~54.75）	19.00（15.00~24.00）	Z=1.56	0.119
CRP[M(P₂₅~P₇₅)]/mg·L^-1	8.88（3.06~13.68）	3.45（0.50~14.73）	Z=1.53	0.126
ESR[M(P₂₅~P₇₅)]/mm·h^-1	15.00（8.25~24.50）	9.00（5.00~33.00）	Z=0.96	0.336
血培养（阳性/阴性）	28/4	5/6	χ²=5.92	0.015

组别	例数	CD3⁺ ($\bar{x} \pm s$)	CD4⁺ [M(P₂₅~P₇₅)]	CD8⁺ ($\bar{x} \pm s$)	CD3⁺CD4^-CD8^- ($\bar{x} \pm s$)	CD3⁺CD4⁺CD8⁺ [M(P₂₅~P₇₅)]	CD19⁺ [M(P₂₅~P₇₅)]	CD56⁺ [M(P₂₅~P₇₅)]
转氨酶异常组	32	81.27±7.63	31.95 （29.80~34.97）	32.06±6.94	15.92±6.65	0.10（0.00~0.20）	9.55 （5.40~16.47）	4.35 （3.05~7.37）
转氨酶正常组	11	79.18±6.16	37.5 （30.10~38.60）	33.50±8.01	10.98±3.69	0.10（0.10~0.20）	15.40 （6.70~18.30）	4.90 （4.50~5.80）
统计量		t=0.81	Z=1.49	t=0.57	t=2.34	Z=0.52	Z=0.91	Z=0.40
P		0.421	0.136	0.573	0.024	0.600	0.366	0.691