成人慢性活动性EB病毒感染并噬血细胞综合征1例

患者,女,36岁,主因间断发热、咽痛7个月,乏力、咳嗽15d入院。患者于2009年6月发热,伴畏寒、咽痛,体温约38～39℃,无其他伴随症状,予输液治疗1周,效不佳,10月初检验巨细胞病毒1gM抗体可疑阳性,EB病毒抗体IgM阴性,IgA阳性。肝功能：ALT 144U/L,AST 259U/L,予静脉滴注更昔洛韦治疗1周后患者体温恢复正常。此后偶有低热、咽痛,未予重视。2010年4月10日患者再次发热,呈弛张热,最高体温40℃,并自觉乏力、咽痛,时有干咳,外院检验血WBC 2.41×10^9/L、N 0.74,RBC 4.18×10^（12）/L,Hb 108g/L,PLT 50×10^9/L。     

慢性活动性EB病毒感染致大量心包积液1例

本文报道1例浙江省丽水市中心医院2018年11月收治的慢性活动性EB病毒感染致反复大量心包积液患者。女,40岁,因胸闷、心悸入院,B超、CT提示大量心包积液,考虑结核性心包炎,给予心包穿刺抽液及抗结核治疗,但患者心包积液复发,后PET-CT检查提示多发淋巴结肿大,行淋巴结穿刺活检发现大量EB病毒感染,经免疫组化、外周血EBV-DNA、EBV抗体、TCR基因克隆性重排检查最终确诊为慢性EB病毒感染,给予SMILE方案(甲氨蝶呤、异环磷酰胺、地塞米松、依托泊苷、培门冬酶)化疗,淋巴结缩小,心包积液消失,但患者化疗期间并发重症肺炎,放弃治疗自动出院。     

慢性活动性EB病毒感染患儿免疫机制及血液学病征分析

目的探讨慢性活动性EB病毒感染(CAEBV)患儿免疫机制及血液学病征。方法选定本院2016年3月至2021年3月收诊的60例CAEBV患儿为观察组,同期择取60例健康体检儿童为对照组。比较两组的分化簇4(CD4⁺)T、分化簇8(CD8⁺)T、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM),并分析观察组患儿的血液学病征。结果观察组的CD4⁺T水平,较对照组低(P<0.05);其中CD8⁺T、IgA、IgG及lgM水平,均较对照组高(P<0.05)。观察组患儿中有42例血液学改变,表现包括1例全血细胞减少(2.38%)、2例类白血病反应(4.76%)、7例血小板减少(16.67%)、6例粒细胞减少症(14.29%)、7例贫血(16.67%)以及28例外周血异型淋巴细胞≥10%(66.67%)。结论CAEBV会导致患儿免疫功能失衡,同时也会引起多种血液学病征,临床治疗期间应加以重视。     

儿童EB病毒感染254例临床分析

目的 了解儿童EB病毒感染的多种临床特征,提高早期诊断水平.方法 对确诊EBV感染的254例儿童临床表现、诊断、预后、实验室检测资料进行回顾性分析.结果 主要临床表现为:发热96.45%、咽痛咽峡炎91.73%、淋巴结肿大81.10%、咳嗽53.54%、肝脏肿大22.83%、脾脏肿大18.89%、皮疹14.96%、眼睑浮肿10.6%等.实验室检查:白细胞升高占77.95%,淋巴细胞＞50%占96.85%,传单中变异淋巴细胞＞0.10占91.14%,肝脏、心肌受损率高.结论 儿童EBV感染临床表现多样,可累及多个系统,以呼吸系统为主,其次为循环系统、血液系统,预后良好,EBV-VCA-IGM的检测有助诊断.     

儿童EB病毒感染15例临床分析

目的:探讨分析儿童EB病毒感染的各种临床表现、实验室检查的情况以及误诊率,以期提高儿童EB病毒感染的诊断水平。方法:回顾性分析ELISA即酶联免疫吸附法检测EBV-VCR-IgM诊断儿童EB病毒感染的15例临床资料。结果:儿童EB病毒感染多表现为发热、咽峡炎、淋巴结增大症状以及肝脾大等,有时候也会出现咳嗽、黄疸、跟睑水肿、皮疹、抽搐症状以及消化道大出血等。经检查还发现外周血白细胞的数目也显著增多,其中最主要的是淋巴细胞的数目增多,还有一部分患者的异性淋巴细胞的数目也增高,早起的EBV-VCR-IgM是呈阳性的。另外,本次试验误诊为5例,由于患者早期症状比较轻、体征少,以其他的一些症状为主要表现,或者在发病初期出现多脏器受累。结论:儿童EB病毒感染症状和体征表现是多种多样的,累及各个脏器,非常容易出现误诊,其中,EBV-VCR-IgM检测对早期的诊断比较有效。     

慢性活动性EB病毒感染编码探讨

慢性活动性EB病毒感染作为一类难治性淋巴增殖性疾病,既往临床和疾病编码领域对之认识不清,相关编码准确性有待探讨。从临床背景着手,查找核对ICD-10和ICD-11的双编码,其难点在于主导词选择,基于定义和诊断标准,首先查找主导词“病”,进而根据提示转换查找主导词“肿瘤”、“免疫缺陷”,注意查验临床信息核对编码。根据患者是否存在遗传性免疫基因缺陷拟推荐两种编码思路,分别分类于肿瘤(ICD-10为D47.9,ICD-11为2B32.Y)或免疫缺陷疾病(ICD-10为D82.3,ICD-11为4A01.22),并需与普通EB病毒感染编码鉴别。该疾病的准确编码直接影响到DRG分组结果的真实性,编码员提高主导词选择技能、结合临床核对编码及合理运用ICD-11等编码工具将会是保证病案首页数据质量的重要前提和机遇。     

286例小儿EB病毒感染的临床特征分析

目的分析小儿EB病毒感染的临床特点,提高诊断率,减少误诊率。方法对经PCR测定EBV—DNA阳性的286例EB病毒感染的患儿临床特点进行回顾性分析。结果EB病毒感染的主要症状有发热占98．7％,咽峡炎86．01％,咳嗽68．89％,皮疹11．19％,淋巴结肿大17.83％,肝脾肿大8．8％,眼睑浮肿2．09％。结论EB病毒感染的患儿临床表现复杂多样,累及脏器多,临床医师应综合分析及早进行相应的检查,做出正确诊断,减少误诊率,进行合理治疗。     

210例小儿EB病毒感染临床分析

目的:分析小儿EB病毒感染的临床特点。方法:对临床诊断为EB病毒感染的患儿临床资料进行回顾性分析。结果:小儿EB病毒感染临床可能与传染性单核细胞增多症、急性上呼吸道感染、病毒性心肌炎、再生障碍性贫血、血小板减少性紫癜、川崎病并与古兰—巴雷综合征、面神经炎、病毒性脑膜炎等有关。新生儿败血症可合并EB病毒感染,可能有致畸作用。结论:小儿EB病毒感染临床表现多样,应用阿昔洛韦或更昔洛韦治疗大多预后良好。     

儿童EB病毒感染279例临床分析

EB病毒（EBV）感染是儿科较为常见的病毒感染性疾病,感染时症状轻重不一,可累及多系统并引起相应的疾病,临床表现多样.笔者对本院2004年3月～2005年3月收治的279例EB病毒感染患儿进行临床分析,现报道如下.     

Clinical analysis and follow-up study of chronic active Epstein-Barr virus infection in 53 pediatric cases

Background Chronic active Epstein-Barr virus infection （CAEBV） has been previously reported to be sometimes associated with an aggressive clinical course. The characteristics of CAEBV in Mainland Chinese pediatric patients are largely unreported. The main aims of this survey were to recognize the clinical features of CAEBV in children and to explore its diagnostic criteria and risk factors. Methods A retrospective study was performed on 53 pediatric patients （36 boys and 17 girls） with CAEBV who were admitted to Beijing Children＇s Hospital between 2003 and 2007. All their medical records were reviewed and analyzed. For each patient, demographic, clinical, laboratory data and outcome were collected. Independent-samples t test was used for statistical analysis. Results The age at onset of CAEBV was from 2 months to 14.6 years （mean （5.3_＋3.3） years）. At the time of onset, 43.4% patients had an infectious mononucleosis-like symptom. Most patients exhibited intermittent fever （92.5%, 49/53）, hepatomegaly （81.1%, 43/53） and splenomegaly （77.4%, 41/53）. Life-threatening complications including hemophagocytic syndrome （24.5%,13/53）, interstitial pneumonia （24.5%, 13/53）, hepatic failure （15.1%, 8/53） and malignant lymphoma （11.3%, 6/53） were also observed. The serum EBV DNA level in 23 patients with CAEBV was in the range of 5.05×10^2-4.60×10^6 copies/ml with a mean value of 103.7 copies/ml. Many patients with CAEBV generally had continuous symptoms during the observational period. Eleven out of 42 patients （26.2%） died 7 months to 3 years after onset. Deceased patients were more likely to have had lower platelet counts and albumin levels than the living patients （P 〈0.05 for all comparisons）. Conclusions The study reveals that CAEBV in Chinese pediatric patients has a severe clinical course and prognosis is poor. Thrombocytopenia and decreases in albumin might potentially be risk factors for a poor prognosis. EBV loads should be measured and tissue should be stained on hybridization probes for EBV-encoded small RNA （EBER） if a patient presents with the known symptoms of CAEBV.     

不同年龄阶段EB病毒感染住院患儿临床症状及实验室检查特点分析

  目的  通过对153例EB病毒感染住院患儿临床资料进行回顾性分析,探讨不同年龄阶段EB病毒感染患儿临床表现及实验室检查特点。  方法  选择2012年1月—2020年1月蚌埠医学院第一附属医院儿科收治的153名EB病毒感染住院患儿的临床资料,根据年龄将其分为3组,分别为婴幼儿期组(1个月~3岁)52例,学龄前期组(3~7岁)57例,学龄期组(7~14岁)44例,对各组患儿的一般资料、临床表现及实验室检查结果进行分析。  结果  发病季节以春夏为主,呈夏高冬低趋势,分别为夏季66例(43.2%),秋季32例(20.9%),春季43例(28.1%),冬季12例(7.8%)。在疾病谱分布中,以传染性单核细胞增多症为主,共62例(40.5%);婴幼儿期组疾病更具有多样性,支气管肺炎、支气管炎等呼吸道疾病亦高发,少数患儿仅仅表现为腮腺肿大。临床表现中,婴幼儿组患儿咳嗽25例(48.1%)、皮疹14例(26.9%),较学龄前期组及学龄期组患儿高;学龄前期组淋巴结肿大36例(63.2%),学龄期组淋巴结肿大26例(59.1%),较婴幼儿组高;婴幼儿组无热有18例(72.0%),较其他2组高,高热有7例(16.7%),较其他2组低。实验室检查显示,谷丙转氨酶(ALT)升高者93例,婴幼儿组ALT升高程度较学龄期组低(P＜0.05)。  结论  不同年龄阶段儿童EBV感染后在疾病分布、临床表现及实验室检查中各有特点,掌握不同年龄阶段疾病特点,有助于疾病的早期发现、早期诊断及早期治疗。      

住院儿童EB病毒感染临床分析

目的:了解云南省昆明市住院患儿EB病毒(EBV)感染状况及相关疾病谱临床流行分布特征.方法:回顾性统计分析疑似EBV感染住院患儿经PCR荧光法检测全血中EBV核酸阳性病例的临床资料.结果:共送检住院患儿血样本547例,EBV核酸检测阳性例数97例,检出率17.73％,其中男56例(57.73％),女41例(42.27％);平均年龄(4.60±2.84)岁,学龄前儿童(0～6岁)76例,占检出人数的78.35％.儿童EBV感染临床症状多样,常以发热、咳嗽、淋巴结肿大等上呼吸道感染症状首诊,多以EB病毒感染、肺炎、支气管炎、传染性单核细胞增多症、咽炎等临床表现为主,可伴有肝-脾等肿大、皮疹、肝脏和心肌损害等并发症状;同时检出合并其他病原体感染71例次,其中肺炎支原体19例(19.59％),伤寒或副伤寒杆菌18例(18.56％),乙型脑炎病毒17例(17.53％),副流感病毒8例(8.25％),肠道病毒2例(2.06％),其他病毒共7例(7.22％),合并感染患儿47例(42.27％);且各季节时段的检出率差异无统计学意义(P>0.05).结论:EBV感染是昆明地区住院患儿呼吸道感染的重要病原体之一,各季节时段均可发病,常呈现与其他病原体混合感染.     

慢性牙周炎患者EB病毒Real-Time PCR检测

目的:探讨EB病毒(EBV)感染水平与慢性牙周炎(CP)的关系.方法:采集30例CP患者深牙周袋标本及牙龈组织,记录牙周袋探诊深度、附着丧失水平、牙龈指数,real-time PCR法检测EBV DNA.12例正畸、8例腭裂修补术患者作正常对照.结果:CP组EBV DNA检出率高于正常对照组(P＜0.05).CP组深牙周袋EBV DNA检出率高于牙龈组织(P＜0.05),但2者EBV DNA水平差异无统计学意义(P＞0.05).CP患者深牙周袋EBV DNA水平与牙龈指数、牙周袋深度和附着丧失水平均不相关(rs分别为0.34、0.64、0.71,P均＞0.05).结论:EBV可能与CP有关,深牙周袋是EBV主要存在部位.     

散发性戊型病毒性肝炎71例临床研究

目的探讨散发性戊型病毒性肝炎的临床特征。方法回顾性分析了71例戊型病毒性肝炎患者的临床和流行病学资料,分别比较老年组与非老年组、单纯戊型肝炎与重叠感染组生化指标。结果戊型肝炎呈全年散在发病;男性多于女性,男女比例为2.6:1,年龄分布在11-79岁,以青壮年高发;老年组患者与其他两组非老年组患者比较,TBIL峰值、ALT峰值差异有统计学意义(P0.05),ALB低值、AST峰值差异无统计学意义(P0.05),而老年组GGT峰值与11-40岁年龄组差别无统计学意义(P0.05),与41-60岁年龄组差别有统计学意义((P0.05);单纯戊型肝炎与重叠乙肝感染组比较,TBIL峰值、GGT峰值、ALB低值、ALT峰值、AST峰值差别无统计学意义(P0.05);黄疸型67例(94.4%),重型肝炎5例,其中3例重叠乙肝感染,死亡1例,病危出院1例,转院3例。结论戊型病毒性肝炎呈全年散在发病,以青壮年和男性多见,以急性黄疸型为主,大多数患者预后良好,但有部分患者病情较重,重叠乙型肝炎感染及老年患者是造成戊型重型肝炎的危险因素。     

重视儿童非肿瘤性EB病毒感染疾病的研究

Epstain-Barr病毒(Epstain-Barr virus,EBV)是一种重要的肿瘤相关病毒,成人感染率超过90%。EB病毒与鼻咽癌、霍奇金和非霍奇金淋巴瘤、胃癌、移植后淋巴增生症等多种肿瘤的发生密切相关。本文介绍了EB病毒感染的实验室诊断方法及其临床应用,重点介绍了儿童常见非肿瘤性EB病毒感染疾病(传染性单核细胞增多症、慢性活动性EB病毒感染、EB病毒相关噬血淋巴组织细胞增生症)的临床特征、诊断指南及需要进一步研究的问题。     

Epstein-Barr virus infection of sinonasal lymphoepithelial carcinoma in Guangzhou

Objectives To investigate the prevalence of sinonasal lymphoepithelial carcinoma (SNLEC) in Guangzhou, a high incidence area of nasopharyngeal carcinoma (NPC), and to dete ct whether it is associated with Epstein-Barr virus (EBV) infection. Methods Twenty confirmed SNLEC specimens were collected from all of the sinonasal carcin oma biopsies performed in the 8 years 1989-1996 at the Sun Yat-sen University o f Medical Sciences. EBV encoded early RNAs were detected by use of in-situ hyb ridization. A variety of antigens, including the EBV nuclear antigen 1, latent membrane protein 1, BZLF1 protein, diffuse early antigen, viral capsid antigen a nd membrane antigen, were detected using immunohistochemistry. Additionally, 36 NPC specimens were used for comparison. Results Twenty SNLECs were identified. Seventeen SNLECs were developed in the nasal cav ity, and 3 in the maxillary sinus. The mean age (46.25 y), male to female ratio (3∶1), histopathology and lymphoinfiltration of the 20 SNLECs were id entical with those of the 36 NPCs. Thirteen (65.0%) of the 20 SNLECs showed an expansive growth pattern, while 27 (75.0%) of the 36 NPCs showed an infiltrat ing or mixed growth pattern. The majority of cancer cells in all of the 20 SNLE Cs showed EBV encoded early RNAs. The EBV nuclear antigen 1 expression of SNLEC was less intensive than that of NPC. The expression rate of latent membrane pr otein 1 for SNLEC (3/20,15%) was lower than that for NPC (19/36, 52.8%). The e xpression rates of BZLF1 protein (2/20, 10.0%), diffuse early antigen (19/20, 9 5.0%), viral capsid antigen (15/20, 75.0%), and membrane antigen (13/20, 65.0 %) for SNLEC were higher than those (0/36, 0.0%; 31/36, 86.0%; 18/36, 50%; and 14/36, 38.9%) for NPC. Conclusions SNLEC is not uncommon in Guangzhou. This tumour is also consistently associated with EBV infection like NPC. As compared to NPC, the EBV harbored in SNLECs s eems to express the EBV nuclear antigen 1 weakly and has a lower expression rate of latent membrane protein 1 as well as higher expression rates of EBV lytic pr oducts.     

Primary nasopharyngeal non-Hodgkin lymphoma and its relationship with Epstein-Barr virus infection

Objectives To investigate the immunophenotypes of primary nasopharyngeal non-Hodgkin lymphoma(NPL) and their relationship to Epstein-Barr virus (EBV) infection.Methods The clinical data and biopsies of 73 patients with NPL were collected in Guangzhou. In situ hybridization was performed to detect the EBV-encoded small non-polyadenylated nuclear RNAs(EBERs) on biopsy slides. Immunohistochemistry was used to classify the immunophenotypes of NPL and detect EBV antigen expression.Results Forty-four (60. 27%) of the 73 NPLs were of B cell lineage (CD79α^ /CD3^-/CD56^-)while the 29 others (39.73%) were of non-B cell lineage. Seventy-three NPLs could be classified into 3 major immunophenotypes: B cell (CD79α^ /CD3^-/CD56 ^-, 44 cases), peripheral T cell (CD79α^-/CD3^ /CD56^-, 22) and NK/T cell (CD79α^-/CD3^ /CD56^ , 7). The percentages of EBV infection differed among the 3 major immunophenotypes ( B cell : 11.36%, 5/44 ; peripheral T cell: 81.82%,18/22; NK/T cell: 100%, 7/7). Both CD56-positive and CD56-negative immunophenotypes could further be divided into 4 subtypes: CD8^-/CD4^-, CD8^ /CD4^- , CD8^-/CD4^ and CD8^ /CD4^ All the CD8^-/CD4^- NPLs with CD56-positivity (7) or CD56-negativity (2) were infected with EBV. The neoplastic cells of a nasopharyngeal Burkitt‘ s lymphoma expressed EBV nuclear antigen 1 (EBNA1)and EBV RNA (EBERs) only. In the other 29 EBV-infected NPLs, most of the lymphoma cells harboring EBV also expressed EBNA1 and EBERs; 21 of the 29 NPLs had a considerable number of neoplastic cells expressing latent membrane protein 1 ( LMP1 ) (21/29, 72.41% ) and 23 of 29 NPLs expressed latent membrane protein 2A (LMP2A) (23/29, 79. 31%). A few lymphoma cells in 17( 17/29, 58. 62% ), 23 (23/29, 79.31% ) and 22 NPLs (22/29, 75.86% ) expressed Zta ( Barn HI Z transactivator), viral capsid antigen (VCA) and membrane antigen (MA), respectively.Conclusions The prevalence ratio of the 3 immunophenotypes, namely, B cell, peripheral T cell and NK/T cell lymphoma, is about 6:3: 1. However, the EBV infection ratio is reversed, 1:8: 10. All the NK/T cell (CD56^ ) and peripheral immature T cell (CD3^ /CD8^-/CD4^-) NPLs were EBV-infected.Except for one Burkitt‘ s lymphoma, the EBV harbored in both B cell and non-B cell NPLs was mainly latent infection, type It, expressing EBNA1, LMP1 and LMP2A. However, the EBV found in a few lymphoma cells could become replicative, expressing lytic proteins.     

糖尿病慢性伤口感染患者的临床特点及伤口愈合的危险因素分析

目的 分析糖尿病慢性伤口感染患者的临床特点及伤口愈合的危险因素。方法 回顾性分析2019年1月至2021年12月浙江省台州医院收治的160例糖尿病患者的病历资料及其糖尿病慢性伤口感染发生率,探讨影响糖尿病慢性伤口感染患者伤口愈合的危险因素。结果 160例糖尿病患者中,90例发生慢性伤口感染,其中呼吸道感染占24.44%,泌尿道感染占18.89%,皮肤软组织感染占21.11%,消化道感染占23.33%,其他感染占12.22%。90例慢性伤口感染患者中共检出119株病原菌,其中耐甲氧西林金黄色葡萄球菌12株,肠球菌7株,铜绿假单胞菌26株,肺炎克雷伯菌14株,鲍曼不动杆菌20株,大肠埃希菌14株,白假丝酵母菌26株。患者年龄≥60岁、高中以下学历、住院时间≥4d、病程≥10年、合并脑血管疾病、有创治疗、血糖≥13.9mmol/L、血液透析、患有糖尿病并发症、应用抗菌药物为影响糖尿病慢性伤口感染患者伤口愈合的危险因素（P<0.05）。结论 年龄、文化程度、住院时间、病程、合并脑血管疾病、有创治疗、血糖、血液透析、糖尿病并发症、应用抗菌药物为影响糖尿病慢性伤口感染患者伤口愈合的危险因素,且主要感染菌为革兰阴性菌,故有效防止感染的发生,对促进患者伤口愈合具有重要意义。     

慢性疲劳综合征82例临床分析

目的分析慢性疲劳综合征(chronicfatiguesyndrome,CFS)患者的临床表现及相关检查结果,为探索病因及治疗方案提供依据。方法对82例CFS患者建立表格病历,总结临床表现;SCL90等量表进行心理学测试;蛋白质印迹法检测血浆中抗博尔纳病病毒(Bornadiseasevirus,BDV)p24抗体;高压气相色谱分析检测红细胞膜上n6脂肪酸水平;酶学方法检测血浆左旋肉碱水平。结果CFS患者年龄主要分布在21～50岁之间,无性别差异,疲劳的伴随症状中,记忆力和/或注意力下降最为突出;大部分患者(57/82)存在SCL90结果异常;与健康对照组相比,CFS患者抗BDV p24抗体阳性检出率高[11%vs0%,χ2=6.673,P=0.010],n6脂肪酸中花生四烯酸(ARA)水平明显低(P<0.05),左旋肉碱水平低[(6±3)vs(8±4),t=2.025,P=0.045]。结论CFS患者以中青年多见,70%合并心理学异常,11%存在BDV感染,部分合并营养及能量代谢障碍。