儿童慢性活动性EB病毒感染临床及实验室检查特征

Clinical and laboratory characteristics of chronic active Epstein-Barr virus infectionin children

摘要:

目的 研究慢性活动性EB 病毒感染(CAEBV)患儿的临床及外周血淋巴细胞亚群等实验室检查特征,为CAEBV 的诊治提供依据.方法 分析13 例CAEBV 患儿的临床资料,包括患儿的临床表现、病毒学检测及淋巴细胞亚群测定结果,并与15 例急性EB 病毒感染(AEBV)病例作对照研究.结果 两组患儿临床表现类似,主要为发热、肝脾肿大、淋巴结肿大等传染性单核细胞增多症(IM)样症状,区别在于CAEBV 患儿病程较长,上述症状持续或反复出现.CAEBV 组患儿外周血EBV-DNA 载量明显高于AEBV 组(P<0.05).CAEBV 组VCA-IgG 明显高于AEBV 组(P<0.05).CAEBV 组外周血白细胞计数、淋巴细胞计数、B 细胞计数、总T 细胞计数、CD4⁺ T 细胞计数和CD8⁺ T 细胞计数均低于AEBV 组(P<0.05).随访13 例CAEBV 患儿,8 例死亡,2 例好转,2 例病情仍有反复,1 例转院后失访.15 例AEBV 患儿均治愈,随访1 年无病情反复.结论 CAEBV患儿临床表现多样,早期较难与AEBV 鉴别,预后差,病死率高.外周血EBV-DNA 载量、VCA-IgG 及淋巴细胞亚群的测定对CAEBV 诊断具有一定帮助.

Abstract:

Objective To study the clinical and laboratory characteristics of chronic active Epstein-Barr virus(EBV) infection (CAEBV) in children and to provide a basis for the diagnosis and treatment of CAEBV. Methods The clinical data of 13 children with CAEBV, as well as 15 cases of acute EBV infection (AEBV) as controls, wereanalyzed, including clinical manifestations, EBV antibodies, EBV DNA, and peripheral blood lymphocyte subsets.Results Both groups of patients had infectious mononucleosis-like symptoms such as fever, hepatomegaly,splenomegaly, and lymphadenectasis, but CAEBV patients had a longer course of disease and continuous and recurrentsymptoms. Compared with the AEBV group, the CAEBV group had a significantly higher EBV DNA load in peripheralblood (P<0.05), a significantly higher VCA-IgG titer (P<0.05), and significantly lower numbers of white blood cells,lymphocytes, B cells, total T cells, CD4⁺ T cells, and CD8⁺ T cells in peripheral blood (P<0.05). Among 13 CAEBVpatients followed up, 8 cases died, 2 cases showed an improvement, 2 cases had a recurrence, and 1 case was lost tofollow-up after being transferred to another hospital. All the AEBV patients were cured and had no recurrence during theone-year follow-up. Conclusions The clinical manifestations of CAEBV vary in children. It is difficult to distinguish CAEBV from AEBV early. More attention should be paid to CAEBV because of its severe complications, poorprognosis, and high mortality. Measurement of EBV DNA load, VCA-IgG titer, and lymphocyte subsets in peripheralblood may be helpful in the diagnosis and differential diagnosis of CAEBV.