Abdominal ultrasonographic findings and gallbladder wall thickening in children with infectious mononucleosis caused by Epstein-Barr virus : clinical-ultrasonographic correlation

Abstract

[한글]

목적: 저자는 Epstein-Barr Virus (EBV) 감염에 의한 감염성 단핵구증 환아에서 복부초음파로 담낭벽의 두께를 측정하고, 혈액검사 소견, 임상 양상들을 비교-분석하여, 담낭벽 비후 소견과 질환의 중증도에 대한 관계를 연구하고자 한다.연구방법: 본 연구는 2001년 1월부터 2004년 12월에 걸쳐 감염성 단핵구증으로 본원 소아과에 입원환 환아 84명을 대상으로 하였다. 총 84명의 환아들의 의무기록 및 복부초음파 소견을 후향적으로 고찰하였다. 환아들은 모두 감염성 단핵구증의 특징적 양상인 발열, 인후염, 그리고, 경부림프절비대를 가지고 있었으며, EBV에 대한 혈청학적 검사에 대하여 양성을 보인 환아를 연구에 포함시켰다. 이들 중 마이코플라스마와 간염 바이러스에 양성을 보인 19명의 환아는 제외되었다. 총 65명의 환아가 최종적으로 연구에 포함되었다. 담낭벽 두께는 복부초음파로 측정하였으며, 담낭벽 비후는 그 두께가 3mm 넘는 경우로 정의하였다. 저자들은 혈액검사소견 및 질환의 경과를 살펴보았으며, 담낭벽 비후 소견을 보이는 환아 군과 보이지 않는 환아 군 사이에서 유의한 차이점을 보이는 항목들을 연구하였다.결과: 담낭벽 비후 소견은 65명 중 24명(34%)의 환아에서 관찰되었다. 평균 입원 일수는 담낭벽 비후를 보인 군에서 그렇지 않은 군보다 유의하게 길었다 (10 ± 3.5 vs 6 ± 2.3; p < 0.05). 총빌리루빈 수치 또한 담낭벽 비후소견을 보인 환아들에게서 유의하게 높았다 (1.2 mg/dl ± 1.8 mg/dl vs 0.3 mg/dl ± 0.2 mg/dl; p < 0.05). 그리고, Aspartate aminotransferase (AST) 수치도 담낭벽 비후소견을 보이는 환아들에서 높았으며 (267 mg/dl ± 332 mg/dl vs 80 mg/dl ± 83mg/dl; p < 0.05), alanine aminotransferase (ALT) 수치도 같은 결과를 보였다 (249 mg/dl ± 284 mg/dl vs 90 mg/dl ± 102 mg/dl; p < 0.05). 그러나, 총단백질, 혈청 알부민, alkaline phosphatase (ALP), 백혈구 수치, C-reactive protein (CRP), 그리고, erythrocyte sedimentation rate (ESR) 수치는 두 군 간에 통계적으로 유의한 차이는 없었다.결론. EBV 감염에 의한 감염성 단핵구증 환아에서 관찰되는 담낭벽 비후소견은 질환의 중증도와 상관관계가 있으며, 그러한 소견을 보이는 환아에서는 보다 면밀한 임상관찰이 요구된다.

[영문]Infectious mononucleosis syndrome may be presented with various clinical courses, but there is no known severity or prognostic index available. We used sonography to measure gallbladder wall thickness in pediatric patients with infectious mononucleosis syndromes caused by Epstein-Barr virus (EBV) and then evaluated laboratory data, and clinical evolution to assess any relationship between gallbladder wall thickening (GBWT) and the severity of disease.We retrospectively reviewed the medical records and ultrasonographies of 84 patients with infectious mononucleosis who were admitted to pediatric clinics between January 2001 and December 2004. Patients fulfilled clinical triad of infectious mononucleosis syndromes on the basis of fever, tonsillopharyngitis, and cervical lymphadenopathy, and showed positive serology for EBV. 19 patients were excluded who had positive serologic results for mycoplasma and hepatitis virus antibodies. Total 65 patients were included in this study. The gallbladder wall thickness in each patient was sonographically determined. GBWT was defined as a wall thickness exceeding 3 mm. We assessed the laboratory data and clinical evolution in each patient, and the differences between patients with and without GBWT were statistically analyzed.GBWT was observed in 24 (34%) of the 65 patients. The mean duration of hospitalization for the patients with GBWT (10 days ± 3.5) was significantly longer than for those without GBWT (6 days ± 2.3; p < 0.05). The total bilirubin level in the patients with GBWT (1.2 mg/dl ± 1.8 mg/dl) was significantly higher than in the patients without GBWT (0.3 mg/dl ± 0.2 mg/dl; p < 0.05). Aspartate aminotransferase (AST) level was significantly higher in patients with GBWT (267 mg/dl ± 332 mg/dl) than those without GBWT (80 mg/dl ± 83mg/dl; p < 0.05). And, alanine aminotransferase (ALT) level was also higher in patients with GBWT (249 mg/dl ± 284 mg/dl) than patients without GBWT (90 mg/dl ± 102 mg/dl; p < 0.05). The total protein, serum albumin, and alkaline phosphatase (ALP) levels were not significantly as also significantly different between two groups. The two groups did not differ significantly in the mean white blood cell (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) levels.GBWT in mononucleosis syndromes may be a sign of the severity of the illness and when present indicates the need to carefully monitor the clinical course.