抗病毒治疗对儿童传染性单核细胞增多症的价值探讨

Value of antiviral therapy for infectious monocytosis in children

摘要:

目的：比较抗病毒治疗与未抗病毒治疗对儿童传染性单核细胞增多症（IM）的近期疗效及远期随访结果，以探讨抗病毒治疗对儿童IM的价值。方法：回顾性复习1999～2009年住院IM患儿病历，符合纳入条件并随访1年以上的病例共172例。根据患儿治疗方案，分为更昔洛韦组(49例)、阿昔洛韦组(72例)和对照组(51例)。更昔洛韦组予静脉滴注更昔洛韦每日10 mg/kg，分2次给予；7 d后改为每日5 mg/kg，每日1次；总疗程10～14 d。阿昔洛韦组予口服阿昔洛韦片，每日20 mg/kg，分3次口服；总疗程10～14 d。对照组仅使用对症治疗。观察各组热程、咽峡炎症状改善、肝脾淋巴结回缩时间、异型淋巴细胞数回降时间及用药后粒细胞数改变等指标。远期随访包括复查血常规、肝功能、肝脾B超，并统计治愈率、复发率和死亡率。结果：急性期3组在热程、咽峡炎的改善、肝脾淋巴结开始回缩时间、异型淋巴细胞数降至10%以下的时间等指标差异均无统计学意义（P>0.05）。随访1年至8年10个月，3组间治愈率、复发率、死亡率差异无统计学意义（P>0.05）。结论：抗病毒治疗与非抗病毒治疗对儿童IM的疗效无明显差异，抗病毒治疗未能使IM患儿获益。

Abstract:

OBJECTIVE: To study the value of antiviral therapy for infectious monocytosis (IM) in children by comparing the near-term therapeutic efficacies and long-term follow-up results in children with this disorder between receiving antiviral therapy or not. METHODS: The medical data of IM children between 1999 and 2009 were retrospectively reviewed. A total of 172 cases with a follow-up visit period of 1 year and more were eligible. The children were classified into three groups according to the treatment protocol: ganciclovir treatment (n=49), acyclovir treatment (n=72) and symptomatic treatment (control; n=51). The children in the ganciclovir group received an intravenous drip of 10 mg/kg per day of ganciclovir, administered in twice-daily doses; Seven days later the drip volume was changed to 5 mg/kg, administered once each day; the total course lasting 10-14 days. The children in the acyclovir group received acyclovir orally at 20 mg/kg per day, administered in three times daily doses; the total course lasting 10-14 days. The children in the control group received symptomatic treatment only. In the three groups, indicators including fever course, improvement of isthmitis symptoms, lymph node retraction, hepatic and splenic lymph node retraction time, atypical lymphocyte fallback time and alteration of granulocyte amount after drug use were observed. The long-term follow-up visits covered such indicators as blood routine reexamination, hepatic function, liver and spleen B-ultrasonography, recovery rate, recurrence rate and mortality rate. RESULTS: In the acute phase, there were no differences in terms of fever course, isthmitis improvement, hepatic and splenic lymph node retraction time and the time of atypical lymphocyte falling back to below 10% among the three groups (P>0.05). During the period of follow-up visits between 1 year and 8 years and 10 months, no significant differences were observed in the recovery rate, the recurrence rate and the mortality rate among the three groups (P>0.05). CONCLUSIONS: The efficacies of antiviral therapy for IM children appear to be similar to non-antiviral therapy, suggesting that antiviral therapy fails to be beneficial for IM children.