EB病毒感染儿童的临床特征与实验室检查结果分析

黄璐

【摘要】 目的：分析EB病毒與其他病原体感染患儿后引起的血常规与生化检验指标的变化特点，探讨各项指标对诊断EB病毒感染的重要意义。方法：收集2017年7月-2019年6月在本院住院部诊治的、临床出现发热、咽炎、淋巴结肿大的798例患儿，进行EB病毒核酸、血常规以及生化项目的检测，并将结果进行统计学分析。结果：与EBV-DHA阴性患儿相比，EBV-DHA阳性患儿红细胞总数、淋巴细胞绝对值、单核细胞绝对值、嗜碱性细胞绝对值、淋巴细胞百分比、嗜碱性细胞百分比均较高，而嗜酸性粒细胞绝对值、嗜酸性粒细胞百分比、单核细胞百分比均较低，差异均有统计学意义（sig<0.05）。与EBV-DHA阴性患儿比较，EBV-DHA阳性患儿L-乳酸脱氢酶、α-羟丁酸脱氢酶和腺苷脱氨酶数值较高，肌酸激酶较低，差异均有统计学意义（sig<0.05）。EBV-DNA载量与ADA分泌水平呈正相关（sig<0.01）。ADA以23.25 U/L为最佳临界值时，其诊断儿童感染EBV的灵敏度和特异度分别为0.654、0.860。结论：EB病毒感染引起的血常规和生化指标的变化有别于其他病原体，腺苷脱氨酶可能是有效判断EB病毒感染的早期指标。

【关键词】 EB病毒 血常规 生化指标

Analysis of Clinical Characteristics and Laboratory Results of Epstein-Barr Virus Infection in Children/HUANG Lu. //Medical Innovation of China， 2020， 17（15）： -152

[Abstract] Objective： To analyze the characteristics of complete blood count and biochemical test in children infected with EBV or other pathogens， and to explore the significance of these indexes in diagnosing EBV infection. Method： A total of 798 children with fever， pharyngitis and lymph nodes treated in our hospital from July 2017 to June 2019 were selected and detected for EBV nucleic acid， complete blood count and biochemical test， and the results were statistically analyzed. Result： Compared with EBV-DNA negative children， the red blood counts， the absolute value of lymphocytes， the absolute value of monocytes， the absolute value of basophils， the percentage of lymphocytes and the percentage of basophils in EBV-DNA positive children were higher， while the absolute value of eosinophils， the percentage of eosinophils and the percentage of monocytes in EBV-DNA positive children were lower， there were statistical significance （sig<0.05）. For biochemical test indexes， the values of L-lactate dehydrogenase， α-hydroxybutyrate dehydrogenase and adenosine deaminase in EBV-DNA positive children were higher， while the values of creatine kinase were lower， the differences were statistically significant （sig<0.05）. The load of EBV-DNA presented a positive correlation with ADA secretion （sig<0.01）. While the best cut-off value of ADA was 23.25 U/L， the sensitivity and specificity of diagnosing EBV infection in children were 0.654 and 0.860 respectively. Conclusion： The changes of complete blood count and biochemical test indexes caused by EBV infection are different from other pathogens. Adenosine deaminase may be an effective early index to diagnose EBV infection.

[Key words] Epstein-Barr virus Complete blood count Biochemical test index

First-authors address： Jiangmen Maternity and Child Health Care Hospital， Jiangmen 529000， China

doi：10.3969/j.issn.1674-4985.2020.15.038

Epstein-Barr Virus（EBV）属于人类γ疱疹病毒，是第一种被发现具有致癌能力的病毒，每年大约有20万的肿瘤发生与EBV有关。发展中国家EBV相关肿瘤的发生率比发达国家要更高[1]。EBV可长期潜伏于人体内，世界上大约有95%的成人携带EBV，多数表现为无症状的长期感染，这种持续性感染跟EBV与B细胞的独特作用有关[2]。EBV可以导致多种疾病的发生，如传染性单核细胞增多症（infectious mononucleosis，IM）、慢性活动性EBV感染（chronic active EBV infection，CAEBV）、EBV相关噬血细胞性淋巴组织细胞增生症（EBV-associated haemophagocytic lymphohistiocytosis，EBV-HLH）、移植后淋巴增生性障碍疾病（posttransplant lymphoproliferative disorders，PTLD）、Burkitt巴瘤、Hodgkins淋巴瘤、非Hodgkins淋巴瘤。EBV也能引起上皮肿瘤的发生，包括鼻咽癌（nasopharyngeal carcinoma，NPC）与EBV相关胃癌（gastric carcinoma，GC）等[3]。

EBV的原发感染可以引起IM的发生，IM的临床“三联征”为发热、咽炎和颈淋巴结肿大，可合并肝脾肿大和肝功能异常，部分病例出现皮疹、眼睑水肿等临床症状，病程较长，治愈过程较痛苦。实验室检查是否感染EBV主要通过血常规、嗜异凝集抗体、肝功能、EBV相关抗体和核酸检测等方法来进行[4]，近几年核酸检测成为诊断EBV感染的重要指标。……