EB病毒相关噬血细胞性淋巴组织细胞增生症患儿的EB病毒感染特征

目的 了解儿童EB病毒(EBV)相关噬血细胞性淋巴组织细胞增生症(EBV-HLH)患儿的EBV血清学抗体及病毒复制水平等特征.方法 对67例EBV-HLH患儿和60例原发性EBV感染所致的传染性单核细胞增多症(EBV-IM)患儿的临床资料进行分析,EBV特异性抗体和血清EBV DNA载量分别采用间接免疫荧光法和荧光定量PCR测定.结果 EBV-HLH患儿EBV特异性抗体结果:EBV-CA-IgM、EBV-CA-IgG、EBV-EA-IgG和EBV-NA-IgG的阳性率分别为28.8％、100.0％、51.5％和78.8％,EBV-VCA-IgG高亲和力为78.9％,低亲和力为12.1％；血清学抗体结果显示,71.2％的患儿为EBV再激活感染,其余为急性原发EBV感染；45.5％的EBV-HLH患儿可在血清中检测到EBV DNA,其拷贝数中位数为1.976×103 copies·L-1.EBV-IM患儿的EBV-CA-IgM、EBV-CA-IgG、EBV-EA-IgG和EBV-NA-IgG阳性率分别为100.0％、100.0％、58.3％和26.7％,EBV-VCA-IgG高亲和力为18.3％,低亲和力为81.7％,EBV DNA阳性率为10.0％,DNA拷贝数均值为8.495 copies·1-1.IM患儿均为EBV原发感染状态.结论 EBV-HLH可发生在EBV原发感染或既往EBV感染再激活时期,但多数患儿由既往EBV感染再激活所致.EBV-HLH患儿血清中EBV复制水平显著高于EBV-IM患儿.

Characteristics of Epstein- Barr Virus Infection in Children with Epstein- Barr Virus -Associated Hemophagocytic Lymphohistiocytosis

Objective To evaluate the characteristics of Epstein-Barr virus(EBV) serological profiles and DNA replication levels in children with EBV associated hemophagocytic lymphohistiocytosis(EBV-HLH).Methods The clinical data of 67 children with EBV-HLH and 60 children with primary EBV-associated infectious mononucleosis(EBV-IM) were analyzed.EBV specific antibodies and serum EBV DNA were measured by means of indirect immunofluorescence assay and polymerase chain reaction,respectively.Results The EBV specific antibodies of children with EBV-HLH were indicated.The positive rates of EBV-CA-IgM,EBV-CA-IgG,EBV-EA-IgG and EBV-NA-IgG were 28.8%,100.0%,51.5% and 78.8%,respectively.The rate of high-avidity antibodies against EBV-VCA was 78.9% and the rate of low-avidity antibodies was 12.1%.Results of serologic antibodies showed that 71.2% of the children were EBV reactivate infection,while the rest of them were primary EBV infection;The serum EBV DNA could be detected from 45.5% children with EBV-HLH,and the median of DNA copies were 1.976×103 copies·L-1.The positive rates of EBV-CA-IgM,EBV-CA-IgG,EBV-EA-IgG and EBV-NA-IgG of the EBV-IM children were 100.0%,100.0%,58.3% and 26.7%,respectively.The rate of high-avidity antibodies against EBV-VCA was 18.3% and the rate of low-avidity antibodies was 81.7%.The positive rate of EBV DNA was 10.0%,the mean DNA copies were 8.495 copies·L-1.All IM children were caused by EBV primary infection.Conclusions EBV-HLH may occur in different stages of EBV infection,and most children with EBV-HLH are the reactivation of past EBV infection.The serum EBV copy level in EBV-HLH children is significantly higher than that of EBV-IM children.