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.     

91例EB病毒相关疾病儿童血浆EB病毒DNA的检测

目的了解EB病毒(EBV)感染患儿外周血血浆中游离EBVDNA的拷贝数,确定EBV原发感染后外周血血浆中EBV游离DNA的拷贝数与发病天数及病情轻重的关系。方法应用荧光定量PCR方法,测定73例EBV原发感染和18例EBV相关重症疾病患儿外周血血浆中EBV游离DNA。结果①原发EBV感染患儿外周血血浆中EBV游离DNA随发病天数呈下降趋势,发病2周后很难检测到。②EBV相关重症疾病组患儿外周血血浆中EBV游离DNA阳性率明显高于原发EBV感染组,差异有显著性(89%vs16%,P<0.05)。结论原发EBV感染后随病程天数的增加,病毒复制水平逐渐下降。血浆中EBV游离DNA检测对评价EBV相关疾病的严重程度有一定参考价值。     

91例EB病毒相关疾病儿童血浆EB病毒DNA的检测

目的:了解EB病毒（EBV）感染患儿外周血血浆中游离EBV DNA的拷贝数,确定EBV原发感染后外周血血浆中EBV游离DNA的拷贝数与发病天数及病情轻重的关系。方法:应用荧光定量PCR方法,测定73例EBV原发感染和18例EBV相关重症疾病患儿外周血血浆中EBV游离DNA。结果:①原发EBV感染患儿外周血血浆中EBV游离DNA随发病天数呈下降趋势,发病2周后很难检测到。②EBV相关重症疾病组患儿外周血血浆中EBV游离DNA阳性率明显高于原发EBV感染组,差异有显著性(89% vs 16%, P＜0.05）。结论: 原发EBV感染后随病程天数的增加,病毒复制水平逐渐下降。血浆中EBV游离DNA检测对评价EBV相关疾病的严重程度有一定参考价值。［中国当代儿科杂志,2009,11（11）：897-900］     

儿童EB病毒感染的免疫功能状况

目的研究EB病毒(EBV)感染儿童免疫功能状况及其与临床和预后的关系。方法用流式细胞仪(FCM)分别对30例传染性单核细胞增多症(IM)患儿急性期、恢复期外周血淋巴细胞CD3 、CD4 、CD8 、CD19 、CD23 抗原进行检测,并与20例同龄健康对照组儿童比较。结果IM患儿急性期CD4 、CD8 、CD19 、CD23 淋巴细胞百分率分别为(14.88±3.14)%,(65.49±5.33)%,(5.70±2.89)%,(2.41±1.83)%,恢复期为(36.75±3.88)%,(41.64±5.11)%,(15.98±2.80)%,(5.02±2.76)%。急性期CD8 明显高于恢复期和对照组,而CD4 、CD19 、CD23 淋巴细胞明显低于恢复期和对照组。恢复期3例CD23 细胞比值较高。结论EBV感染儿童外周血淋巴细胞亚群明显异常,CD23 细胞的持续增高与CD4 T细胞的长期低下有可能成为评价IM预后的指标。     

中山市儿童EB病毒感染情况分析

目的了解广东省中山市儿童EB病毒(EBV)感染情况及流行特征。方法回顾性分析2011至2013年经实时荧光定量PCR检测外周血中单个核细胞EBV-DNA的疑似EBV感染患儿的临床资料。结果 3 402例疑似EBV感染患儿中,EBV-DNA检出阳性409例,总阳性率为12.0%。其中2011年阳性率为8.1%,2012年为10.4%,2013年为19.5%,三年阳性率差异有统计学意义(P0.05);不同性别患儿间的差异无统计学意义(P0.05);不同年龄组间的差异有统计学意义(P0.05),以学龄前组为最高。EBV感染性疾病以传染性单核细胞增多症为最多(61.6%),其次为呼吸道感染(26.7%)、颈淋巴结炎(3.4%)、血小板减少性紫癜(2.4%)等。在部分EBV感染患儿中,检出MP-IgM阳性79例,CP-Ig M阳性47例,细小病毒B19-IgM阳性20例,单纯疱疹病毒IgM阳性11例,巨细胞病毒IgM阳性10例,风疹病毒Ig M阳性4例。结论中山市儿童EBV-DNA阳性年检出率呈上升趋势,EBV感染后以传染性单核细胞增多症最常见,但可累及多个系统。EBV感染后可能伴有多种病原抗体阳性。     

肾病综合征血清可溶性白细胞介素2受体检测的临床意义

肾病综合征血清可溶性白细胞介素２受体检测的临床意义吴衡生，王韵琴，杨渝珍目前认为血清可溶性白细胞介素２受体（ＳＩＬ一２Ｒ）测定是衡量体内免疫功能的一种有效的新方法，我们测定了２６例单纯性肾病综合征（简称肾病）患儿血清ＳＩＬ一２Ｒ，并对其临床意义进行初...     

儿童EBV感染的非肿瘤性相关疾病

EBV是一种亲人类B细胞的疱疹病毒.EBV可引起全身各系统和器官的疾病,包括肿瘤性和非肿瘤性相关疾病[1].在儿童非肿瘤性EBV感染相关性疾病中,传染性单核细胞增多症(IM) 、慢性活动性EBV感染(CAEBV)和EBV相关噬血淋巴组织细胞增生症(EBV-HLH) 最具临床意义.IM是良性自限性疾病,而CAEBV和EBV-HLH具有潜在恶性倾向,预后不良.本文就首都医科大学附属北京儿童医院(我院)诊断的IM、CAEBV和EBV-HLH各1例典型病例进行分析,以期提高对该类疾病的认识.     

肺炎支原体肺炎患儿血清白细胞介素-10、可溶性白细胞介素-2受体水平的临床意义

目的　探讨肺炎支原体 (MP)肺炎患儿血清白细胞介素 10 (IL 10 )、可溶性白细胞介素 2受体 (sIL 2R)水平测定的临床意义。方法　测定MP肺炎患儿 2 6例、普通肺炎 18例急性期及恢复期IL 10、sIL 2R水平 ,并与正常对照组比较。结果　急性期MP肺炎组IL 10较正常对照组明显下降 ,有显著性差异 (P <0 .0 1) ;普通肺炎组与正常对照组无差异 (P >0 .0 5) ;恢复期两组与对照组比较无差异。急性期MP组和普通肺炎组患儿sIL 2R明显增高 ,与对照组比较有显著性差异 (P均 <0 .0 5) ;恢复期MP组患儿sIL 2R下降不明显 ,普通肺炎组患儿明显下降 (P >0 .0 5)。结论　sIL 2R增高显示细胞免疫功能受抑 ,IL 10在MP肺炎患儿低水平 ,显示机体免疫失衡 ,与疾病恢复慢、住院时间长有关     

EB病毒抗体检测在儿童EBV感染相关疾病诊断中的应用价值

目的探讨EBV四种抗体(VCA-IgM、VCA-IgG、EA-IgG、EBNA-1-IgG)在儿童EB病毒感染相关疾病中的应用。方法采用酶联免疫吸附法(ELISA)检测78例EB病毒感染儿童血清样本的EBV四种抗体。结果(1)病例年龄2月~15岁,中位年龄3岁,<4岁53例,4~8岁16例,>8岁9例;(2)78例患儿传染性单核细胞增多症51例(65.4%),呼吸道感染7例(9.0%),另外还有原发性血小板减少性紫癜、急性再生障碍性贫血、肾炎、过敏性紫癜、肝炎及隐性感染病例。(3)VCA-IgM阳性57例,阳性率73.1%;结论EBV四种抗体能动态反应EB病毒感染后的抗体水平,其敏感性高、特异性强、检测方法简单,在EB病毒感染相关疾病诊断中很有价值,非常值得推广。     

哮喘患儿血一氧化氮,可溶性白细胞介素2受体及IgE变化

目的探讨哮喘患儿外周血一氧化氮（NO）、可溶性白细胞介素2受体（SIL-ZR）及IgE的变化。方法支气管哮喘急性发作期患者44例，男23例，女21例，对照组为15例健康儿童，男9例，女6例。分别在哮喘急性发作期和缓解期采静脉血，测定NO、SIL-ZR和IgE，并与对照组进行比较。结果支气管哮喘息性发作期患者与缓解期患者（30例）皿中NO分别为107.99±24.96μmol／L和81.36±14.31μmol／L（P＜0.001）;SIL-ZR分别为259.55±58.82kU／L和213.23±33.72kU／L（P＜0.001）;IgE分别为932.61±637.23kU／L和760.80±53644kU／L（P＞0.05）。对照组血中NO为82.26±14.21，与急性发作期哮喘息者相比，有显著性差异（P＜0.001）。结论支气管哮喘急性发作期患儿血中NO和SIL-2R均明显高于缓解期患者和健康儿童。内源性NO在哮喘的发病中可能发挥着重要作用。     

Infectious mononucleosis as a disease of early childhood in Japan caused by primary Epstein-Barr virus infection

The present study investigated 54 pediatric patients with acute Epstein-Barr virus (EBV)-induced infectious mononucleosis (IM) in Japan. Most of the acute cases clustered within the first 5 years of life, and the peak incidence was observed at around 4 years of age. These patients were arbitrarily separated into three age groups (less than 3 years, 3–5 years, and 6–14 years). Fever, pharyngitis, lymphadenopathy and hepatomegaly were detected in more than 80% of all cases. Tonsillitis and splenomegaly were present in about 60% of cases. Skin manifestations and eyelids edema were less often detected in the older age group than in the younger age groups. In addition to an increase of total white blood cell and lymphocyte counts in the peripheral blood, a significant increase in the percentage of CD3⁺ CD8⁺ HLA-DR⁺ T cells was always observed. Epstein-Barr virus seropositivity increased soon after birth and reached approximately 70% around 3 years of age. Close to 100% of the adult controls were EBV seropositive. The results suggest that EBV-induced acute IM is a disease of early childhood in Japan.     

EB病毒感染相关噬血细胞综合征的诊治研究进展

噬血细胞综合征(hemophagocytic syndrome,HS)是一组病因及发病机制复杂.组织病理表现以良性组织细胞增生活化,伴随噬血细胞现象的一类综合征.HS分为原发性和继发性两大类,原发性是指家族遗传相关的免疫缺陷状态,继发性指后天获得所致,其中以EB病毒感染相关最为常见.EB病毒感染相关HS的病情进展快,病死率高,现就该病的诊治进展作一概述.     

Variations in serum soluble IL-2 receptor concentration

Soluble interleukin-2 receptor (sIL-2R) concentrations were measured in the sera of 18 healthy adult volunteers, 40 healthy children aged 5 months - 16 years 8 months and cord blood from 10 babies, using two commercially available ELISA kits (T-cell Sciences and Serotec). In the presence of normal C-reactive protein (CRP) children (aged 0-16 years 8 months) had significantly higher sIL-2R concentrations than adults aged (18-37 years). In children up to the age of 16 years there was a significant negative correlation between age and sIL-2R (r = -0.725 p < 0.0001 T-Cell Sciences, r = -0.646 p < 0.0001 Serotec). A comparison was also made between the two kits, which indicated that both kits yielded reproducible results but the T-Cell Sciences kit had a larger working concentration range than the Serotec kit. Following 12-h sampling in adult volunteers, a lower concentration of sIL-2R was observed at 4 am compared with 10 am (p = 0.0052) which indicates diurnal variation. These observations emphasize the importance of the study of normals as part of any research, and raises further questions regarding the many factors which influence immune function.     

Systemic type Epstein-Barr virus-related lymphoproliferative diseases in children and young adults: challenges for pediatric hemato-oncologists and infectious disease specialists

Involvement of Epstein-Barr virus (EBV) has long been known in the development of various tumor-forming proliferating diseases, such as nasopharyngeal carcinoma in adults. However, in children and young adults more attention should be focused on systemic, severe type EBV-related diseases, such as fatal infectious mononucleosis, hemophagocytic syndrome, or chronic active EBV infection (CAEBV). These disorders show the typical clinical features of hemophagocytic lymphohistiocytosis (HLH). Although viral infectious diseases are mostly taken care of by infectious disease specialists, pediatric hemato-oncologists need to intervene in the treatment of this kind of disease because of their clonal and neoplastic disease characteristics and of their hematologically problematic, rapid, and life-threatening clinical courses.     

儿童传染性单核细胞增多症临床特点与发病年龄的关系:附312例分析

目的 探讨儿童传染性单核细胞增多症(IM)的临床特点与发病年龄的关系.方法 312例IM儿童分成0 ～ 3岁、～ 6岁、～ 15岁3组,进行回顾性分析.结果 IM儿童中6岁以下占74.4%,春季和秋季高发.0 ～ 3岁组发热天数平均(7.08 ± 3.31)d,～ 6岁组平均(7.91 ± 3.78)d,～ 15岁组平均(12.38 ± 4.14)d,～ 15岁组与其他组差异有统计学意义(P ＜ 0.01).各年龄组咽峡炎(100%)、淋巴结肿大(82.69%)、肝肿大(66.7%)、脾肿大(62.5%)、鼻塞(42.3%)组之间差异无统计学意义(P ＞ 0.05);眼睑浮肿(36.2%)～ 15岁组明显低于其他组(P ＜ 0.05),皮疹(23.1%)在0 ～ 3岁组多见(P ＜ 0.05).外周血白细胞年幼儿升高明显,异型淋巴细胞年幼儿偏低,血清ALT、AST在年长儿偏高,血清LDH在各年龄组均呈高值,血清嗜异凝集试验年长儿阳性率高.结论儿童IM某些临床特点与发病年龄有关,应予以重视,以提高确诊率.     

Epstein-Barr Virus Infection and Serological Profile in Greenland Eskimo Children

ABSTRACT. The Epstein-Barr virus (EBV)-specific antibody profile of 101 Greenland Eskimo children was determined. The proportion of children with serological evidence of recent or past primary EBV infections rose from 22 % at 6 months of age to 79 % at 24 months of age. All but 2 of 49 children more than 4 years of age proved seropositive. The geometric mean titre (GMT) of antibodies to the viral capsid antigen (VCA) was highest during the first 3 years of life and declined sharply to a lower, nearly constant level in older children. The GMT of antibodies to the nuclear antigen (EBNA), rose slowly during the first 4 years of life to its persistent level. None of the children had a history of illnesses comparable to infectious mononucleosis. The results have shown that in this population with an enhanced risk of nasopharyngeal carcinoma, primary EBV infection occurs at a very early age.     

儿童传染性单核细胞增多症并发EB病毒相关性噬血细胞综合征临床危险因素分析

目的 比较传染性单核细胞增多症(infectious mononucleosis,IM)和EB病毒相关性噬血细胞综合征(EBV-associated hemophagocytic syndrome,EBV-AHS)的临床特点,分析IM患儿发生EBV-AHS的临床危险因素.方法 回顾性比较我院2000年1月至2006年4月430例IM和EBV-AHS患儿临床症状、体征和实验室检查特点,采用Logistic回归分析IM患儿发生EBV-AHS的临床危险因素.结果 (1)本组IM病例中EBV-AHS发生率为3.72%(16/430),EBV-AHS组患儿热程明显长于IM组患儿,体温峰值、肝脏和脾脏肿大程度均较IM组患儿明显,但咽峡炎发生率(37.5%)显著低于IM组(91.1%),差异均有统计学意义.(2)EBV-AHS组外周血三系均低于IM组,且变异淋巴细胞升高不明显,其比例(中位数10%)显著低于IM组(中位数18%),差异亦有统计学意义.(3)EBV-ASH组肝功能损害显著重于IM组,尤其乳酸脱氢酶(LDH)(中位数为2128.5 U/L)和天冬氨酸氨基转移酶(AST)(中位数为489 U/L)水平升高显著高于IM组,且常伴有高胆红素血症及低白蛋白血症.(4)多因素Logistic回归分析发现:热程＞10 d(OR=8.097)、LDH进行性升高＞1000 U/L(OR=7.998)、低白蛋白血症(OR=7.838)、中性粒细胞＜1.5×109/L(OR=7.587)和血小板＜100×109/L(OR=7.190)是本组IM患儿发生EBV-AHS的临床危险因素,本组EBV-AHS病死率高达50%.结论 绝大多数IM患儿呈良性自限性过程,约3.7%患儿进展为EBV-ASH.热程＞10 d、LDH＞1000U/L、低白蛋白血症、中性粒细胞＜1.5×109/L、血小板＜100 x 109/L是IM患儿发生EBV-AHS的临床危险因素,该病预后凶险,病死率高,多次骨髓检查有助于及时诊断.