儿童噬血细胞综合征与人微小病毒B19感染的相关性及临床特征分析

Clinical features of childhood hemophagocytic syndrome and its association with human parvovirus B19 infection

摘要:

目的 探讨儿童噬血细胞综合征(HPS)与人微小病毒B19(HPVB19)感染可能存在的相关性,并对其临床特征进行分析.方法 采用酶联免疫吸附试验(ELISA)和荧光定量PCR 法对65 例HPS 患儿(HPS 组)及65 例健康体检儿童(对照组)进行HPVB19 IgM、IgG 及HPVB19 DNA 检测,并根据HPVB19DNA 检测结果将HPS 患儿分为HPVB19 感染组(n=14)和非感染组(n=51),比较两组患儿临床资料.结果 HPS 组HPVB19-IgM 阳性率(26%,17/65)显著高于对照组(9%,6/65)(P=0.011);而HPVB19-IgG阳性率(38%,25/65)与对照组(29%,19/65)比较差异无统计学意义(P=0.266).HPS 组HPVB19 感染率(22%,14/65)明显高于对照组(3%,2/65)(P=0.001).与HPVB19 非感染组HPS 患儿比较,感染组患儿入院时血小板计数与血红蛋白水平显著降低,肝功能损伤更严重,发病时间更早,病程迁延时间更长(均P<0.05).结论 HPVB19 感染与HPS 发病可能具有相关性.HPVB19 感染的HPS 患儿起病更急,临床表现更为严重,病程迁延时间更长.

Abstract:

Objective To investigate the association of childhood hemophagocytic syndrome (HPS) with human parvovirus B19 (HPVB19) infection, and to analyze the clinical features of this disease. Methods ELISA and quantitative real-time PCR were used to detect HPVB19-IgM, HPVB19-IgG and HPVB19-DNA in 65 children with HPS (HPS group) and 65 healthy children (control group). The HPS group was divided into HPVB19-infected (n=14) and non-infected (n=51) groups according to the detection results of HPVB19-DNA. The clinical data of two groups were compared. Results The positive rate of HPVB19-IgM in the HPS group (26%, 17/65) was significantly higher than that in the control group (9%, 6/65) (P=0.011), and there was no significant difference in the positive rate of HPVB19-IgG between the HPS (38%, 25/65) and control groups (29%, 19/65) (P=0.266). The infection rate of HPVB19 in the HPS group (22%, 14/65) was significantly higher than that in the control group (3%, 2/65) (P=0.001). Compared with the noninfected group, the HPVB19-infected group had significantly lower platelet count and hemoglobin level on admission, significantly more severe liver function damage, a significantly earlier onset time, and a significantly longer course of disease (P<0.05). Conclusions The pathogenesis of HPS may be associated with HPVBl9 infection. HPVBl9-infected children with HPS have more acute onset, more severe clinical manifestations, and a longer disease duration.