274例青少年和成人传染性单核细胞增多症患者肝损伤临床特征分析

目的分析青少年和成人传染性单核细胞增多症(IM)患者肝损伤的临床特征及影响因素。方法回顾性分析2005年1月1日—2018年12月31日北京大学第一医院住院的青少年和成人IM患者的肝损伤特征,按照年龄、血清EBV DNA水平、是否合并黄疸、是否合并巨细胞病毒及HEV感染分为不同亚组,比较亚组间的各项指标的差异。计量资料符合参数分析条件者2组间比较采用t检验,不符合参数分析条件者2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验或Fisher精确概率法。多因素分析采用logistic回归分析。结果共纳入274例患者,其中男154例(56.2%),女120例(43.8%);发病平均年龄为(22.3±6.7)岁。肝损伤(定义为ALT>50 U/L和/或AST>40 U/L)发生率为97.4%(267/274),黄疸发生率27.6%(74/268)。年龄≥20岁者GGT更高(Z=2.070,P=0.038)。167例患者检测了血清EBV DNA,其中阳性组90例,阴性组77例。血清EBV DNA阳性组比阴性组的GGT(Z=3.005,P=0.003)及LDH(Z=2.162,P=0.031)水平更高。合并巨细胞病毒感染组ALP更高(Z=2.351,P=0.019);合并HEV感染组GGT(Z=1.988,P=0.047)更高。AST(OR=1.006,95%CI:1.002~1.010,P=0.005)和ALP(OR=1.012,95%CI:1.005~1.020,P=0.001)为影响黄疸发生的独立危险因素。结论青少年和成人IM患者肝损伤发生率很高,其中年长者和血清EBV DNA阳性者的肝损伤更严重。

Features of liver injury in adolescents and adults with infectious mononucleosis:A single-center retrospective clinical study of 274 cases

Objective To investigate the features of liver injury and related influencing factors in adolescents and adults with infectious mononucleosis(IM).Methods A retrospective analysis was performed to investigate the features of liver injury in adolescents and adults with IM who were hospitalized in Peking University First Hospital from January 1,2005 to December 31,2018,and the patients were divided into subgroups based on age,Epstein-Barr virus(EBV)DNA level,and presence or absence of jaundice or infection with cytomegalovirus or hepatitis E virus(HEV).The t-test was used for comparison of continuous data meeting analytical conditions between two groups,and the Mann-Whitney U test was used for comparison of continuous data which did not meet analytical conditions between two groups;the chi-square test was used for comparison of categorical data between two groups,and the Fisher’s exact test was used for comparison of categorical data which did not meet the analytical conditions of the chi-square test.A logistic regression analysis was used for multivariate analysis.Results A total of 274 patients were enrolled,with 154 male patients(56.2%)and 120 female patients(43.8%),and the mean age of onset was 22.3±6.7 years.The incidence rate of liver injurydefined as alanine aminotransferase(ALT)>50 U/L and/or aspartate aminotransferase(AST)>40 U/L]was 97.4%(267/274),and that of jaundice was 27.6%(74/268).The patients,aged≥20 years,tended to have a higher level of gamma-glutamyl transpeptidase(GGT)(Z=2.070,P=0.038).Serum EBV DNA was measured for 167 patients,among whom 90 had positive results and 77 had negative results.The positive serum EBV DNA group had significantly higher levels of GGT(Z=3.005,P=0.003)and lactate dehydrogenase(Z=2.162,P=0.031)than the negative serum EBV DNA group.The patients with cytomegalovirus infection tended to have a higher level of alkaline phosphatase(Z=2.351,P=0.019),and the patients with HEV infection presented with a higher level of GGT(Z=1.988,P=0.047).AST(odds ratioOR]=1.006,95%confidence intervalCI]:1.002-1.010,P=0.005)and ALP(OR=1.012,95%CI:1.005-1.020,P=0.001)were independent risk factors for jaundice.Conclusion There is a high incidence rate of liver injury in adolescents and adults with IM,and the patients with an older age or positive serum EBV DNA tend to have more severe liver injury.